The issue of dental problems linked to medications has previously been discussed on the blog.
- “After the rot sets in” told the story of someone on the antipsychotic olanzapine who developed crumbling and rotting teeth.
- “Can antidepressants make you less attractive” touched upon dental problems linked to antidepressants.
- “Gray Hair, Rotting Teeth, Semi-Blind and Demented” described a number of concerns about long-term medication use.
The risks to oral health from antidepressants used to be mitigated by the fact that treatment was recommended to last only a few weeks. However, there are now large numbers of people taking antidepressants for months or even years, predominantly because they’ve become chemically dependant on them and run into withdrawal problems when they try to stop.
Dry mouth
Dry mouth (xerostomia) is a fairly common side effect of antidepressants. It might seem like a trivial problem, but its importance shouldn’t be underestimated. Saliva is the mouth’s natural defence against bacteria, and a reduction in saliva can lead to bad breath and tooth decay. Bad breath can be difficult to detect by the person themselves so you may not realise that you have it. For anyone taking an antidepressant, and particularly if you’re aware of having a dry mouth, it’s very important to pay attention to oral hygiene.
Teeth grinding
Teeth grinding (bruxism) can be particularly destructive to teeth. The difficulty is that it’s most common during sleep which means the affected person has no control over it or may not even realise it’s happening. Teeth grinding is part of a wider set of problems that SSRIs can cause, namely dystonias and dyskinesias of the jaw. These dystonias can manifest as tension, pain or clenching of the jaw, and may be quite common in patients who are taking SSRIs. Dyskinesia results in uncontrollable and abnormal movements.
For more information about SSRI-associated bruxism, see the review of published case reports by Garrett and Hawley (2018).
Dental implants
The loss of a tooth or multiple teeth, particularly those that are clearly visible to other people, can be detrimental to a person’s self-image and confidence. In the past, this problem was often overcome by the use of a denture or partial denture, or by the use of a bridge.
A more modern and potentially more expensive solution is a dental implant. This is a false tooth which is drilled and secured into the bone. The success of the procedure depends on how well the implant secures to the bone, and this is where antidepressants could be a problem. There is increasing evidence that SSRIs and related drugs may increase the failure rate of dental implants.
“Selective Serotonin Reuptake Inhibitors and the Risk of Osseointegrated Implant Failure” by Wu et al was published in 2014. It looked at 490 patients who were treated with dental implants between January 2007 and January 2013, 51 of whom were using SSRIs. The study found that the failure rates were 4.6% for non-SSRI users and 10.6% for SSRI users. It’s not clear from the published paper whether other serotonin reuptake inhibitors such as SNRIs were included in the non-SSRI group.
A subsequent pilot study from the University of Buffalo reported that the use of antidepressants increased the odds of implant failure by four times, with each year of antidepressant use doubling the odds of failure.
“Relationship between Selective Serotonin Reuptake Inhibitors and Risk of Dental Implant Failure” by Carr et al was published in 2019. It investigated a cohort of patients receiving dental implants over a 20 year period. The findings appear to contradict the earlier papers by failing to find an increased risk of implant failure while patients were taking an SSRI. However, the interesting part is that it reported a 60% increase of implant failure in patients who had previously used sertraline. This would suggest that the risk of implant failure was essentially a post-SSRI effect. The study also noted: “The findings also suggest that use of multiple SSRIs significantly increases risk of implant failure.”
“Effects of different antidepressant classes on dental implant failure: A retrospective clinical study” by Hakam et al was published in 2021. It looked at patients who received dental implants at the University of Florida from 2011 to 2016. The study found that users of antidepressants were at higher risk of implant failure than non-users. Interestingly, the authors found that tricyclic antidepressants and SNRIs had the highest failure rates, although it noted that the conclusions about tricyclics were based on a small number of cases.
To understand why SSRIs and related drugs might increase the risk of dental implant failure, we need to consider their effect on bones.
Bone density
SSRIs can thin bones and it isn’t known how long after stopping the antidepressant that bone density returns to normal or whether it always does.
“Evaluation of the effect of long-term use of antidepressants in the SSRI group on bone density with dental volumetric tomography” by Agacayak et al was published in 2019. It found significant differences in bone density between patients using SSRIs compared to the control group, describing these findings as “suggestive of osteoporosis”. The study concluded: “Long-term use of antidepressants should be taken into consideration as a risk factor for osteoporosis in men.”
“The effect of selective serotonin reuptake inhibitors on the human mandible” by Coşgunarslan et al was published in 2021. Significant differences were found in the mandibular bone structure (jaw bone) of patients who were using SSRIs compared to the control group.
Taken together with the studies about dental implants, it would appear that antidepressants can not only cause dental problems in the first place but may also limit the success of some restorative procedures.
Gingival hyperplasia
Gingival hyperplasia or gum hyperplasia is a condition in which the gums overgrow. It has a number of different causes including poor oral hygiene, a genetic predisposition, some health conditions, and as a side effect of some medications.
The US product label for paroxetine lists gum hyperplasia as a side effect. Interestingly, this document from the American Dental Association lists gum hyperplasia for both paroxetine and sertraline, although the product label for sertraline doesn’t mention it.
Receding gums
The opposite problem to gingival hyperplasia is receding gums. This is where the gums shrink back and expose more of the tooth underneath causing it to look longer. Gums can recede for a number of reasons including gum disease and brushing too hard. It can also occur naturally to some degree as we age.
In terms of a link to antidepressants, dry mouth can lead to inflammation and gum disease which in turn can potentially lead to receding gums. Teeth grinding can also cause the gums to recede.
Once gums have receded, there is no easy solution. Restorative treatment typically involves some form of gum graft surgery where tissue is taken from the palate (roof of the mouth) and attached either underneath or on top of the existing gum.
Tell us more
Dental problems linked to antidepressants are probably under-reported and under-recognised. We need your help to build a better picture of these issues.
If you’re experiencing any dental problem that you think might be linked to your current use or previous use of an antidepressant, we would appreciate it if you could complete a RxISK Report.
For example:
- Are you developing problems with your teeth and gums despite practising good oral hygiene?
- Are your gums receding at a rate that seems out of step with your age?
- Have you had any dental work fail unexpectedly?
- Have you had any unusual experiences with local anesthetic during dental procedures?
We are also interested to hear about your experiences with dentists. Are they recognising that your problem may be due to antidepressants or do they deny a link?
ANON says
If this poison induces dental issues, imagine how the rest of the body is impacted?
It’s all about $$$$ and the health industry is generating lots of money out of all this balderdash.
It’s dishonest, dirty and ruthless business.
These poisons are unsafe for human consumption.
Anon says
This is an abuse of peoples trust. It is no different to a breach of fiduciary duty. It is no different to some siblings who help themselves to finances when their parents are sick and frail. Instead of benefiting their parents, they help themselves. The health establishment is no different. This is beyond sick!
christine says
since seroxat I have to have the non adrenaline injection at the dentist, dentist made a mistake one time and I was like off into another world and he put an oxygen machine on my finger and kept talking to me saying dont close your eyes, it did pass but was not nice. Never had this before seroxat. Also I have a problem with fillings now and had a tooth out and the nerve still plays up now and then.
Justin Oxley says
I think he probably put a pulse oximeter on your finger which has a perfusion index reading. You can get an objective indication of an anesthetic working by watching the PI. It’s to do with peripheral vasodilation that occurs in response to sedation. I’m going to look at that a bit after I take my sleeping supplements I forgot I owned a pulse oximeter but I remembered it just now when I was thinking about anesthetics. I would prefer a continuous PI data log but my watch only records my ecg and sleeping data. My watch has SpO2 but no PI to measure that I must put my stand alone pulse oximeter on my finger it only cost £20.
Justin Oxley says
I believe my teeth have shown accelerated deterioration, it is difficult for me to be precise about this. A few years back I needed multiple fillings in my back teeth. My dentist made a comment that I needed to try harder with brushing my teeth and I had gum issues he was quite shocked. I was at my local dentist at Bush Fair, I was given the local anesthetic injections in my gums but I couldn’t sit still in the chair. I was sent off to a dentist in Romford where they took x-rays and then I had to attend 3 separate appointments where I was given a general anesthetic before the work was done. That is a few years ago now I know my teeth have shown further crumbling but I don’t like to look in my mouth. I’ve had success at DIY reparation using DenTek Tekparin Max. I have a feeling I will be sent to the Romford dentist again if I turn up at my local practice again it is right next door to the place where my GP hangs out. I might have more success sitting still in the chair now I have been taking supplements, however the weather is getting very hot and after just a short walk out in the Sun hyperhidrosis tends to wear me down. I am not sure how best to proceed, my teeth need work but withdrawal symptoms make it difficult to complete the exercise. Dentists don’t understand this stuff anymore than GPs, given the situation I have a tendency to resort to my own dental care efforts. I don’t have access to the best tools to be doing my own dental work, I have alot of tools and fishing equipment in my front shed which includes artery forceps and pliers but I have a hunch a dentist has much better equipment than I have.
tim says
Aware that fillings last perhaps a year only, then fall out. Careful (self) dental hygiene does not appear to protect.
Multiple phone calls to try to arrange urgent dental care; eventually successful today. Spoke to compassionate and caring dental nurse: – hence eventual success.
Extensive on-line health questionnaire stressful for loved one, comprehensively drug-wrecked by unnecessary ADs and multiple psychotropic drugs for misdiagnosed akathisia/ADRs.
At least they ask if patients are taking bisphosphonates now. Suggest: Dental Profession not aware of the prescription drug induced dental wreckage under discussion here.
ANON says
A few years ago, I visited a local dentist for a filling and oral hygiene appointment.
Charged like a wounded bull : (
The filling only lasted a couple of months and was redone.
The second time it was redone, I was charged dental benefits only. It ended coming out again. Sadly, incisal filling repairs never last!
Did not bother to get it repaired!
It seems like tertiary dentin had formed where application of filling had been unsuccessful ~ I got lucky! (Did not have to find a dentist to replace it- Phew!
They applied fluoride with an applicator to every tooth.
Tasted like poison and it made all my teeth very sensitive for three months.
The poisonous taste remained in my mouth for quite a while.
Noticed the enamel of my maxillary and mandibular incisal edges had become thin and translucent.
Never had fluoride applied like that to my teeth!
I wonder if BIG PHARMA are making products to ruin peoples teeth just to generate $$$$ for business or whether the fluoride was spent? ~ I will never be seeing that dentist again!
I’m fortunate I can scale and clean my own teeth however, for people who don’t have the tools, knowledge or products ~ I really feel for them!
Some dentist still hand out antibiotics for old infections and I wonder if they really know what they are doing?
Periapical or bitewing x-rays, sadly do not give a full snap shot of underlying dental issues of the entire mouth. A Mandibular tori, calcium deposit, bacterial infection or oral cancer can be be misdiagnosed as some dental condition.
How many times have I seen virgin teeth being unnecessarily extracted?
ANON says
I have also witnessed so many teeth undergoing unnecessary treatment, all for the love of money.
Teeth with fine hairlike fractures, that could of been saved and were extracted. I cannot believe how the industry still allows this systemic abuse to occur?
Is it all about saving teeth or generating money?
Sometimes, when a tooth is beyond repair and badly diseased, people have no choice however, sometimes people have a choice and if they have no knowledge, they can easily be ‘hoodwinked!’
Case study:
This poor lady, presented with diseased pulp of molar tooth, abscess on apex of roots and in addition to this had a fine hairline # on the mid-line of the buccal surface (?).
The tooth was not mobile and had no existing restoration. The tooth was unblemished apart from a diseased pulp. They informed her furcation was involved (?).
To the naked eye and on the x-ray, there was no evidence of this occurring.
They told this poor lady that the tooth needed to be extracted because there was no way it could be saved. Are you for real?
The poor lady was ingesting furosemide.
From my knowledge and understanding of this wretched medication, teeth cannot be extracted because cancer can evolve in the bone of the mandible and maxilla.
We had to do everything to save that tooth. The patient had no choice despite professionals saying, otherwise.
That tooth was saved.
They had the first treatment to remove the infection and the necessary medicine was applied however, due to root canals being calcified, it was pointless making this poor patient pay for root canal treatment and having a crown put on top of the tooth after root canal treatment. If this process was undertaken, through many years of experience, that poor tooth would eventually be extracted due to weak root structures and tooth eventually failing. Not to mention other nasties that can occur with root canal treatment. I will not go there!
The tooth was saved and everything was done to minimally not impact that tooth or cause further harm to that patients life.
Which makes me wonder??????
How many Doctors kill because of medication and procedures, putting many lives at RXISK?
How many deaths are due to medical negligence, just like a virgin tooth undergoing unnecessary extraction?
Sadly, we will never know the truth!