Conglomeration of antipsychotics and stomatology – A systematic review

Dr. Karthik  Shunmugavelu; Dr. Vijay  Subramani; Vaishnavi  C

doi:10.51168/sjhrafrica.v6i12.2483

Authors

Dr. Karthik Shunmugavelu Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tamil Nadu, India
Dr. Vijay Subramani Assistant Professor, Department of Psychiatry, Annapoorna Medical College and Hospital, Salem, Tamil Nadu, India
Vaishnavi C Undergraduate (MBBS), PSP Medical College Hospital and Research Institute, Tamil Nadu, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2483

Keywords:

Dental status, Mental disorder, Oral health, Periodontal status, Psychotic disorders

Abstract

Background

Individuals with severe mental illness (SMI) experience disproportionately high rates of dental caries, periodontal disease, tooth loss and salivary dysfunction. Second-generation antipsychotics (SGAs), widely prescribed for schizophrenia, bipolar disorder and related conditions, may further influence oral health through xerostomia, extrapyramidal effects and behavioral changes affecting hygiene practices.

Methodology

Electronic searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science and LILACS for studies published between 2020 and 2024. Original research articles evaluating oral health status or oral-health-related outcomes in individuals with SMI receiving antipsychotic therapy, particularly SGAs, were included. Reviews, editorials and irrelevant publications were excluded.Study selection followed PRISMA guidelines. Extracted data included author, year, country, study design and principal outcomes. Methodological quality was assessed using the STROBE checklist. Due to heterogeneity in study design and outcome reporting, findings were synthesized narratively.

Results

Four eligible studies met the inclusion criteria. Evidence indicates that individuals with schizophrenia and related disorders demonstrate significantly poorer oral health compared to controls, including higher caries prevalence, periodontal disease, and reduced dental service utilization. Antipsychotic-associated xerostomia, medication adherence patterns, and barriers to care were recurrent themes. Preventive dental engagement remains limited in this population.

Conclusion

Individuals with SMI receiving SGAs require structured preventive dental programs, routine oral screening, and interdisciplinary collaboration between psychiatry and dentistry.

Implications

Integrating oral health assessment into psychiatric care pathways may reduce morbidity and improve quality of life.

Author Biographies

Dr. Karthik Shunmugavelu, Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tamil Nadu, India

is an Assistant Professor in the Department of Dentistry at PSP Medical College Hospital and Research Institute, Tamil Nadu, India. He holds BDS, MDS (Oral Medicine and Forensic Pathology), MSc (London), MFDS (RCS England), MFDS (RCPS Glasgow) and academic affiliations with professional bodies in Ireland, Edinburgh, the United States and Australia. His research interests include oral-systemic interactions and interdisciplinary clinical research.

Dr. Vijay Subramani, Assistant Professor, Department of Psychiatry, Annapoorna Medical College and Hospital, Salem, Tamil Nadu, India

is an Assistant Professor in the Department of Psychiatry at Annapoorna Medical College and Hospital, Salem, Tamil Nadu, India. His academic interests include psychopharmacology, schizophrenia-spectrum disorders and integrated psychiatric care models.

Vaishnavi C, Undergraduate (MBBS), PSP Medical College Hospital and Research Institute, Tamil Nadu, India

is an undergraduate MBBS student at PSP Medical College Hospital and Research Institute, Tamil Nadu, India. Her academic focus includes psychiatry, public health and interdisciplinary clinical research.

References

Bhugra D, Ventriglio A, Castaldelli-Maia J, McCay L, editors. Urban mental health. Oxford University Press; 2019 Jun 11.

Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association between mental health and oral health status and care utilization. Frontiers in Oral Health. 2022 Feb 7;2:732882. https://doi.org/10.3389/froh.2021.732882 PMid:35199101 PMCid:PMC8859414

Slack‐Smith L, Hearn L, Scrine C, Durey A. Barriers and enablers for oral health care for people affected by mental health disorders. Australian dental journal. 2017 Mar;62(1):6-13. https://doi.org/10.1111/adj.12429PMid:27164018

Hansen C, Curl C, Geddis-Regan A. Barriers to the provision of oral health care for people with disabilities. BDJ in Practice. 2021 Mar;34(3):30-4. https://doi.org/10.1038/s41404-021-0675-x PMCid:PMC7938029

Matevosyan NR. Oral health of adults with serious mental illnesses: a review. Community mental health journal. 2010 Dec;46(6):553-62. https://doi.org/10.1007/s10597-009-9280-x PMid:20039129

Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosomatic medicine. 2015 Jan 1;77(1):83-92. https://doi.org/10.1097/PSY.0000000000000135 PMid:25526527

Locker D, Matear D. Oral disorders, systemic health, well-being and the quality of life. Toronto, ON: Community Health Services Research Unit. 2000. (DOI: not available)

Joury E, Kisely S, Watt RG, Ahmed N, Morris AJ, Fortune F, Bhui K. Mental disorders and oral diseases: future research directions. Journal of Dental Research. 2023 Jan;102(1):5-12. https://doi.org/10.1177/00220345221120510 PMid:36081351

Jerjes W. The critical intersection of mental health and oral health in severe mental disorders. Clinical Oral Investigations. 2024 Nov 5;28(11):627. https://doi.org/10.1007/s00784-024-06015-4PMid:39496980

Silva GC, Firmino RT, Nogueira AB, Massoni AC, D'Ávila S. Parental emotions in families of children and adolescents with and without autism spectrum disorder. Brazilian Oral Research. 2024 Nov 8;38:e106. https://doi.org/10.1590/1807-3107bor-2024.vol38.0106 PMid:39536207 PMCid:PMC11552460

Khairunnisa Z, Siluvai S, Kanakavelan K, Agnes L, Indumathi KP, Krishnaprakash G. Mental and Oral Health: A Dual Frontier in Healthcare Integration and Prevention. Cureus. 2024 Dec 23;16(12). https://doi.org/10.7759/cureus.76264

Burke RE. Tardive dyskinesia: current clinical issues. Neurology. 1984 Oct;34(10):1348-https://doi.org/10.1212/WNL.34.10.1348 PMid:6148718

Clark GT, Ram S. Four oral motor disorders: bruxism, dystonia, dyskinesia and drug-induced dystonic extrapyramidal reactions. Dental Clinics. 2007 Jan 1;51(1):225-43. https://doi.org/10.1016/j.cden.2006.09.002PMid:17185068

Schwartz M, Hocherman S. Antipsychotic-induced rabbit syndrome: epidemiology, management and pathophysiology. CNS drugs. 2004 Apr;18(4):213-20. https://doi.org/10.2165/00023210-200418040-00002 PMid:15015902

Eltas A, Kartalcı Ş, Eltas ŞD, Dündar S, Uslu MO. An assessment of periodontal health in patients with schizophrenia and taking antipsychotic medication. International Journal of Dental Hygiene. 2013 May;11(2):78-83. https://doi.org/10.1111/j.1601-5037.2012.00558.x PMid:22583707

CHO MA, KO JY, KIM YK, KHO HS. Salivary flow rate and clinical characteristics of patients with xerostomia according to its aetiology. Journal of oral rehabilitation. 2010 Mar;37(3):185-93. https://doi.org/10.1111/j.1365-2842.2009.02037.x PMid:2000253

Tamam L, Annagur BB. Black hairy tongue associated with olanzapine treatment: a case report. Mount Sinai Journal of Medicine. 2006 Oct 1;73(6). PMID: 17117318

Godoy T, Riva A, Ekström J. Atypical antipsychotics-effects of amisulpride on salivary secretion and on clozapine‐induced sialorrhea. Oral diseases. 2012 Oct;18(7):680-91. https://doi.org/10.1111/j.1601-0825.2012.01926.x PMid:22458406

Roerig JL, Mitchell JE, De Zwaan M, Crosby RD, Gosnell BA, Steffen KJ, Wonderlich SA. A comparison of the effects of olanzapine and risperidone versus placebo on eating behaviors. Journal of clinical psychopharmacology. 2005 Oct 1;25(5):413-8.https://doi.org/10.1097/01.jcp.0000177549.36585.29 PMid:16160615

Fratto G, Manzon L. Use of psychotropic drugs and associated dental diseases. The International Journal of Psychiatry in Medicine. 2014 Oct;48(3):185-97. https://doi.org/10.2190/PM.48.3.dPMid:25492713

Heaton LJ, Swigart K, McNelis G, Milgrom P, Downing DF. Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study. Journal of the American Pharmacists Association. 2016 Jul 1;56(4):412-7. https://doi.org/10.1016/j.japh.2016.03.009 PMid:27263421 PMCid:PMC4958601

deVries M, Peeters F. Dental caries with longterm use of antidepressants. Lancet (London, England). 1995 Dec 16;346(8990):1640. https://doi.org/10.1016/S0140-6736(95)91980-5 PMid:7500792

Lalloo R, Kisely S, Amarasinghe H, Perera R, Johnson N. Oral health of patients on psychotropic medications: a study of outpatients in Queensland. Australasian Psychiatry. 2013 Aug;21(4):338-42. https://doi.org/10.1177/1039856213486308 PMid:23671224

Gandhi P, Saxena A, Pai K, Ongole R. Oral manifestations of psychotropic drugs on the oral cavity: observational study. The Journal of Contemporary Dental Practice. 2022 Jul 11;23(4):443-6. PMID: 35945839 https://doi.org/10.5005/jp-journals-10024-3327 PMid:35945839

Persson K, Olin E, Östman M. Oral health problems and support as experienced by people with severe mental illness living in community‐based subsidised housing-a qualitative study. Health & Social Care in the Community. 2010 Sep;18(5):529-36. https://doi.org/10.1111/j.1365-2524.2010.00931.x PMid:20561079

McDonagh M, Peterson K, Raina P, Chang S, Shekelle P. Avoiding bias in selecting studies. Methods guide for effectiveness and comparative effectiveness reviews [Internet]. 2013 Feb 20. (DOI: not available)

Woelber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P, Al-Ahmad A, Tennert CJ. An oral health optimized diet can reduce gingival and periodontal inflammation in humans-a randomized controlled pilot study. BMC oral health. 2016 Jul 26;17(1):28. https://doi.org/10.1186/s12903-016-0257-1PMid:27460471 PMCid:PMC4962497

Staudte H, Sigusch BW, Glockmann E. Grapefruit consumption improves vitamin C status in periodontitis patients. British dental journal. 2005 Aug;199(4):213-7. https://doi.org/10.1038/sj.bdj.4812613 PMid:16127404

Giles EL, Robalino S, McColl E, Sniehotta FF, Adams J. The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis. PloS one. 2014 Mar 11;9(3):e90347. https://doi.org/10.1371/journal.pone.0090347PMid:24618584 PMCid:PMC3949711

Ciancio SG. Medications' impact on oral health. The Journal of the American Dental Association. 2004 Oct 1;135(10):1440-8. https://doi.org/10.14219/jada.archive.2004.0055 PMid:15551986

Torales J, Barrios I, González I. Oral and dental health issues in people with mental disorders. Medwave. 2017 Sep 21;17(08). https://doi.org/10.5867/medwave.2017.08.7045 PMid:28937973

Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis. 1993 Nov 1;103(2):205-11. https://doi.org/10.1016/0021-9150(93)90263-T PMid:8292096

Hale G, McNab D. Developing a ward round checklist to improve patient safety. BMJ Open Quality. 2015 Jan 1;4(1):u204775-w2440. https://doi.org/10.1136/bmjquality.u204775.w2440 PMid:26734369 PMCid:PMC4645926

Teng PR, Su JM, Chang WH, Lai TJ. Oral health of psychiatric inpatients: a survey of central Taiwan hospitals. General Hospital Psychiatry. 2011 May 1;33(3):253-9. https://doi.org/10.1016/j.genhosppsych.2011.03.001 PMid:21601722

Shekarchizadeh H, Khami MR, Mohebbi SZ, Ekhtiari H, Virtanen JI. Oral health of drug abusers: a review of health effects and care. Iranian journal of public health. 2013 Sep;42(9):929. PMID: 26060654

Wadhawan A, Reynolds MA, Makkar H, Scott AJ, Potocki E, Hoisington AJ, Brenner LA, Dagdag A, Lowry CA, Dwivedi Y, Postolache TT. Periodontal pathogens and neuropsychiatric health. Current topics in medicinal chemistry. 2020 Jun 1;20(15):1353-97. https://doi.org/10.2174/1568026620666200110161105 PMid:31924157

Reisine ST. The impact of dental conditions on social functioning and the quality of life. Annual review of public health. 1988 May;9(1):1-9. https://doi.org/10.1146/annurev.pu.09.050188.000245 PMid:3288228

Campos LA, Costa MA, Bonafé FS, Marôco J, Campos JA. Psychosocial impact of dental aesthetics on dental patients. International dental journal. 2020 Oct 1;70(5):321-7. https://doi.org/10.1111/idj.12574 PMid:32476147 PMCid:PMC9379174

Kalaigian A, Chaffee BW. Mental health and oral health in a nationally representative cohort. Journal of Dental Research. 2023 Aug;102(9):1007-14. https://doi.org/10.1177/00220345231171108 PMid:37246825 PMCid:PMC10403957

Ylöstalo PV, Ek E, Laitinen J, Knuuttila ML. Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors. Journal of dental research. 2003 Mar;82(3):194-9. https://doi.org/10.1177/154405910308200309 PMid:12598548

Hallett G, Witton R, Mills I. A survey of mental wellbeing and stress among dental therapists and hygienists in South West England. Bdj Team. 2023 Apr 21;10(4):30-5. https://doi.org/10.1038/s41415-022-5357-5 PMid:36513756 PMCid:PMC9746560

Giannakopoulos NN, Keller L, Rammelsberg P, Kronmüller KT, Schmitter M. Anxiety and depression in patients with chronic temporomandibular pain and in controls. Journal of dentistry. 2010 May 1;38(5):369-76. https://doi.org/10.1016/j.jdent.2010.01.003PMid:20079799

Jathanna RV, Bangera R, Naik MK, Jathanna VR, Adhikari S, Vats S. Unraveling the relationship between oral habits and anxiety: a narrative review. Journal of Pharmacy and Bioallied Sciences. 2024 Dec 1;16(Suppl 4):S3099-101. https://doi.org/10.4103/jpbs.jpbs_744_24PMid:39927035 PMCid:PMC11805172

Cockburn N, Pradhan A, Taing MW, Kisely S, Ford PJ. Oral health impacts of medications used to treat mental illness. Journal of affective disorders. 2017 Dec 1;223:184-93. https://doi.org/10.1016/j.jad.2017.07.037PMid:2875986

Abed H, Ezzat Y, Alsaadawi L, Almarzouki R, Aboulkhair R, Alqarni A, Sharka R, Ezzat Sr Y. Negative impacts of psychiatric medications on oral health: A literature review. Cureus. 2023 Dec 4;15(12). doi: 10.7759/cureus.49915 https://doi.org/10.7759/cureus.49915

Falisi G, Rastelli C, Panti F, Maglione H, Quezada Arcega R. Psychotropic drugs and bruxism. Expert opinion on drug safety. 2014 Oct 1;13(10):1319-26. https://doi.org/10.1517/14740338.2014.947262 PMid:25195948

Halonen H, Nissinen J, Lehtiniemi H, Salo T, Riipinen P, Miettunen J. The association between dental anxiety and psychiatric disorders and symptoms: a systematic review. Clinical practice and epidemiology in mental health: CP & EMH. 2018 Aug 31;14:207. https://doi.org/10.2174/1745017901814010207 PMid:30288171 PMCid:PMC6142663

Patel PS, Ghezzi EM, Ship JA. Xerostomic complaints induced by an anti‐sialogogue in healthy young vs. older adults. Special Care in Dentistry. 2001 Sep;21(5):176-81. https://doi.org/10.1111/j.1754-4505.2001.tb00251.x PMid:11803641

Chu NS. Neurological aspects of areca and betel chewing. Addiction biology. 2002 Jan;7(1):111-4. https://doi.org/10.1080/13556210120091473 PMid:11900630

Millsop JW, Wang EA, Fazel N. Etiology, evaluation and management of xerostomia. Clinics in dermatology. 2017 Sep 1;35(5):468-76. https://doi.org/10.1016/j.clindermatol.2017.06.010 PMid:28916028

Selwitz RH, Ismail AI, Pitts NB. Dental caries. The Lancet. 2007 Jan 6;369(9555):51-9. https://doi.org/10.1016/S0140-6736(07)60031-2 PMid:17208642

Slade GD, Spencer AJ, Roberts-Thomson KF. Australia's dental generations: the national survey of adult oral health 2004-06. (DOI: not available)

World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992.

Cormac I, Jenkins P. Understanding the importance of oral health in psychiatric patients. Advances in psychiatric treatment. 1999 Jan;5(1):53-60. DOI: https://doi.org/10.1192/apt.5.1.53 https://doi.org/10.1192/apt.5.1.53

Page MM. Psychotropic drugs and dentistry. Australian Prescriber. 2007 Aug 1;30(4). https://doi.org/10.18773/austprescr.2007.059

Robb ND, Smith BG, Geidrys-Leeper E. The distribution of erosion in the dentitions of patients with eating disorders. British Dental Journal. 1995 Mar;178(5):171-5.https://doi.org/10.1038/sj.bdj.4808695 PMid:7702952

Harwood MP, Newton JT. Dental aspects of bulimia nervosa: implications for the health care team. European Eating Disorders Review. 1995 Jun;3(2):93-102. https://doi.org/10.1002/erv.2400030205

Riddhi Ritesh Agrawal, Mrunal Meshram, Oral Lesions in Psychiatric Disorder Patients, J Res Med Dent Sci, 2022, 10 (9): 214-217. (DOI: not available)

Naslund JA, Aschbrenner KA, Scherer EA, Pratt SI, Bartels SJ. Health promotion for young adults with serious mental illness. Psychiatric Services. 2017 Feb 1;68(2):137-43. https://doi.org/10.1176/appi.ps.201600091 PMid:27799016 PMCid:PMC5425088

Adams CE, Wells NC, Clifton A, Jones H, Simpson J, Tosh G, Callaghan P, Liddle P, Guo B, Furtado V, Khokhar MA. Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial. International Journal of Nursing Studies. 2018 Jan 1;77:106-14. https://doi.org/10.1016/j.ijnurstu.2017.10.005 PMid:29078109

Macnamara A, Mishu MP, Faisal MR, Islam M, Peckham E. Improving oral health in people with severe mental illness (SMI): a systematic review. PLoS One. 2021 Dec 1;16(12):e0260766. https://doi.org/10.1371/journal.pone.0260766 PMid:34852003 PMCid:PMC8635332