After the Rot Sets In: Teeth on Treatment

Print Friendly, PDF & Email
August 28, 2017 | 26 Comments

Comments

  1. I’ve had 4 back teeth removed since coming off Seroxat. Hard to say if Seroxat was the cause, even harder to prove in court, given that GSK won’t even admit to there being a severe withdrawal problem with Seroxat.

    I continue to suck steaks.

  2. After what i have been through with the PSSD and withdrawal from benzos, nothing surprises me about these drugs anymore.

    I wouldn’t be at all surprised if these drugs were causing peoples teeth to fall out/ rot away.

    When will people wake up and smell the coffee about the damage these drugs can cause?

  3. I had tooth grinding on Seroxat and Citalopram and had dry mouth. I have since had extensive work done, several fillings and root canals done and have lost enamel and had to be prescribed high doses of fluoride toothpaste. Dry mouth is the main cause because saliva cleans and protects teeth of plaque and bacteria. Chewing gum with xylitol can help protect the teeth because it increases saliva, bacteria and helps to strengthen teeth but I would not recommend if you have fillings. Just swirl mouth regularly with water several time a day especially after eating.

    My advise is to “NOT TO USE AN ELECTRIC TOOTHBRUSH” if your teeth are fragile as it will only cause more fractures, loss of fillings and wear down enamel. Use a normal toothbrush and don’t brush hard. Flossing is ok but don’t tug between teeth.

    A vast majority of psychiatric medications cause dry mouth and is well known for destroying teeth.

    There should be warnings about it and advise on how to help protect teeth more whilst on medication.

    Either the drug companies and regulators ignore this for financial reasons or they are completely thick to not know this.

    • Thanks for reminding me Anne- Marie – my dentist diagnosed tooth grinding as well – I was completely unaware of it, but believe it is an established adverse effect of APs – but I question whether grinding your teeth is sufficient for the catastrophic damage Shane describes? Ditto an electric toothbrush…especially one with a soft head.

      • I should have added that I was also told by two different dentists that my teeth were also very soft. She told me not to use an electric toothbrush as I had loss of enamel.

        Dentine is the centre of the teeth its soft and yellow but its the enamel on the outside that strengthens the teeth and gives it that white look. I think its the loss off enamel that’s the cause of the problem.

        Loss of enamel is caused by many things including medications.

        I think using an electric toothbrush including a soft brush on teeth that have loss of enamel can worsen the damage. Is it not a bit like using a sander which will only wear down the enamel even more? Not to mention knock out any white filling you might have.

  4. Clenching and Grinding and Side Effects in the Mouth…some studies

    Six months later, she was recommenced on paroxetine but this had to be discontinued owing to a re-emergence of intense tooth-grinding. Dental consultation revealed that five of her bottom front teeth were dramatically worn down. Four were ‘built up’ but one had to be crowned. The problem cleared on discontinuing paroxetine.

    From The Tooth Fairy – Rxisk.org

    https://davidhealy.org/wp-content/uploads/2012/05/1995-Dystonias-and-dyskinesias-of-the-jaw.pdf

    Antidepressants: Side Effects in the Mouth

    Patrícia Del Vigna de Ameida, Aline Cristina Batista Rodrigues Johann, Luciana Reis de Azevedo Alanis, Antônio Adilson Soares de Lima and Ana Maria Trindade Grégio Pontifícia Universidade Católica do Paraná & Universidade Federal do Paraná Brazil

    1. Introduction

    Oral reactions to medications are common and affect patients’ quality of life. Almost all classes of drugs, particularly those used continuously, such as antidepressants, antihypertensives, anxiolytics, hypnotics, diuretics, antipsychotics among others, including vitamins, minerals and phyto-pharmaceuticals, may cause oral alterations. If not suitably treated, these may aggravate the patient’s general state of health and affect his/her oral health

    http://cdn.intechopen.com/pdfs/29338/InTech-Antidepressants_side_effects_in_the_mouth.pdf

    Risks for Oral Health With the Use of Antidepressants

    Abstract

    In this article, attention is focused on oral pathology, particularly dental caries, caused by hyposalivation as a consequence of (long-term) use of antidepressants. Changes in clinical psychiatric practice and increasing numbers of prescriptions of antidepressants in primary care and specialty care settings have made awareness of this risk even more relevant than in the past. Normal physiology of salivary glands and changes in the secretion of saliva during use of antidepressants are described. Monitoring, prevention, and treatment of hyposalivation induced by antidepressants are encouraged as an adjunct in the clinical management of depression.

    http://www.sciencedirect.com/science/article/pii/S0163834398000176

    A study done by the University of Buffalo connects the use of antidepressants with a 4 times increase in the odds of failure in dental implants AND that each year of antidepressant use doubles the odds of failure.

    https://pharmaden.net/2016/07/18/antidepressants_dental_implants/

  5. I developed bruxism (teeth grinding) during my 8 years on meds but this is something that one of my parents had so it’s been attributed to being hereditary.

    When you say things happening elsewhere in the body, I’d like to bring up something that’s happened to me. I hope it’s not too off-topic to be useful.

    When I was dealing with tolerance withdrawal symptoms while taking a benzodiazepine, this is going to sound crazy, but I had so much itching at night due to undiagnosed tolerance withdrawal that I thought we had bed bugs, so I was cleaning and laundering everything constantly for about a month. During this time I started experiencing weakness in my hands and wrists and after many tests and reassurance that I was simply very mentally ill (and an anti-psychotic was added), the itching bothered me less, I quit all the cleaning, and my wrists and hands improved somewhat. I do remember, though, giving up plans to go bow hunting with relatives because using the bow still put a lot of strain on my hands and wrists (and of course this was crazy talk to them at the time, and still would be except both of them are dead now, though the pain of social alienation is not…but I digress).

    This would all be ancient history except that last year I attempted a career change of sorts where I was working 30 hours a week in agriculture. After 6 weeks I had overuse injuries in my hands that prevented me from continuing any work at all for a few months. Long story short, I cannot use my hands much without experiencing problems.

    My guess has been that the sleep problems I developed while in tolerance withdrawal were inhibiting the muscle and tissue repair that happens during sleep. And I’m guessing that is what I’m dealing with now since the post-benzo sleep issue is ongoing.

    Especially frustrating because doctors assume insomnia is a psychological or behavioral issue that I need to “unlearn,” and when I ask them to make the connection to the overuse injuries most just kind of stare off into space.

    • I have problems with my hands as well! Weakness and pain, particularly in the thumb joints. I recently weaned myself off 15mgs of Zopiclone nightly. This med is a nonbenzodiazepine hypnotic agent used in the treatment of insomnia. Zopiclone is molecularly distinct from benzodiazepine drugs and is classed as a cyclopyrrolone or hypnotic. But I’m experiencing the same symptoms as you. I took this for 12 years!

      • We seem to have another Mary on board? The comment above is certainly not mine – my hands work just fine thanks and those drugs have been nowhere near my digestive system! Shall call myself Mary H. if we do have an extra Mary commenting so we know who’s who.

  6. https://www.nationalelfservice.net/publication-types/systematic-review/tooth-loss-three-times-higher-in-people-with-serious-mental-illness/

    This link gives the accepted reason for people on antipsychotics having terrible teeth – I believe there’s far far more to it. Shane, this is a horrific story – having good teeth is utterly fundamental to self-esteem – and to being able to eat. I can identify with the impact of loss of teeth, as it happened to me although not so dramatically. I cannot imagine that a dry mouth alone could cause such devastating damage.

    I believe losing 10 of my teeth was down (probably) to olanzapine/Zyprexa, which I took for 12 years. I actually began getting mouth abscesses (what we used to call gum boils!) almost as soon as I began antidepressants, then, very rapidly, a cocktail of psychotropics: ADs, ‘mood stabilisers’ including lithium and lamotragine, risperidone, benzos, zopiclone and olanzapine. Zyprexa/olanzapine was the drug I took for longest.

    The gum abscesses soon became tooth abscesses. I underwent too many sessions of root canal work to recall. Root canal treatment is ghastly and very painful and it was all for nothing, as each time, after a few weeks, I had to have the tooth removed anyway. A couple, my wisdom teeth, just literally fell out. One or two molars cracked dramatically – once when I was eating a piece of bread (?). The rest were lost to abscesses. Interestingly, all were back teeth. My front ones are still intact. Dental treatment isn’t free in the UK and constantly visiting the dentist was very expensive.

    In addition, my teeth went dramatically brown in colour. I’m a smoker, which doesn’t help, but also scrupulously careful about thorough cleaning and flossing except for relatively short periods when I was too ill to care. I’d always visited the dental hygienist every 6 months for a proper scrub…but the brown staining was impervious to professional cleaning too.

    By the time I’d stopped taking olanzapine – and years after the last antidepressant – I couldn’t eat solid food, as I had nothing to chew with. All I could do was mumble at soft food. I asked my dentist to do what he could to give me a decent set of gnashers: that meant extensive bridgework on the upper jaw – and a ‘plate’ i.e dentures on the lower. It was lengthy work and extremely expensive (one point which is made here sometimes and is absolutely relevant is that restoration of one’s appearance costs a deal of money). The process took about 9 months. As it turned out, my mouth didn’t take kindly to the dentures and I abandoned them eventually – but as a consequence of the permanent new teeth up top I can eat.

    I too tried to find out any established link between psychotropics and tooth decay, especially antipsychotics. I could find nothing online, and when I asked my dentist he said, tactfully, that it was probably down to poor mouth care (it wasn’t). The hygienist was quite willing to confirm a link between patients with stained teeth and antidepressants, but only insofar as ADs cause dry mouth, which affects saliva. Anyway, that isn’t true (I believe?) for the SSRIs etc – it was the old tricyclics which turned one’s mouth to sawdust.

    I’ve made various conjectures: olanzapine affects blood cells, so is it something to do with an altered immune system, failing to fight off infection? Is it something affecting soft tissue like gums? Does Zyprexa cause a change in bones and teeth? What causes the dramatic discolouration? I actually have no idea. Prevailing wisdom has it that people ill enough to be on olanzapine will have terrible mouth hygiene, and smoke, so any impact on teeth is a secondary matter. I’m damn sure it isn’t.

    But, since stopping Zyprexa back in 2012, I haven’t had a single abscess or lost another tooth. And my teeth are far less stained and, hopefully, a tad less brown.

    It’s impossible to overestimate the terrible impact of looking like a toothless crone, (and not being able to chew). It adds to the effect that antipsychotics have on appearance – weight, skin, hair, teeth – we end up looking like shit, absolutely inadvertently, which reinforces all the deep prejudice about people with serious mental illness. Best of luck with the rest of your treatment.

    • Lying in bed last night another link in the story came to mind. Back in the 1980s when tardive dyskinesia was a big thing, there were a lot of articles linking tooth loss to tardive dyskinesia. Clearly a lot of mouth movement, bruxism as Laurie mentions can cause tooth problems, but the 1980s work suggested it was almost the other way around – tooth loss came before tardive dyskinesia.

      D

    • As well as the expense most dental work doesn’t last either and can also be very painful. Ten years is about the max time before more work needs doing or you have to give up. Veneers last approx 10/15 and screwed in teeth need replacing every 15/20 years if your lucky enough to not have problems with them. This very common and people have to have them removed.

      It can cost 30/40 thousand to have your whole mouth replaced with screwed in teeth and most people have problems that end up being replaced with dentures.

      Saliva is very important:

      Calcium, phosphate and fluoride found in saliva, are required for effective remineralization and maintenance of the enamel surface integrity. Therefore, as saliva is rich in calcium and phosphate ions, It can act as a natural buffer to neutralise acid and allow demineralised tooth tissues to be remineralised.

      They will also be able to regrow enamel one day in the future. They can regrow dentine apparently with a drug used for Alzheimer,Tideglusib. If a drug can regrow dentine then drugs must be able to destroy them too.

      http://www.dailymail.co.uk/health/article-4101996/Could-end-fillings-Scientists-create-method-regrow-teeth-using-Alzheimer-s-drug.html

      https://www.dhealth.com.au/breakthrough-enamel-regrowth/

  7. There are quite a lot of articles about TD and specifically the mouth and teeth so just to keep it brief here are two relating to David’s comment ..

    Journal of Dental Health, Oral Health and Therapy

    Dental Management of Patients with Drug Induced Tardive Dyskinesia (TD)

    With drug induced tardive dyskinesia..
    http://medcraveonline.com/JDHODT/JDHODT-01-00007.php

    These results indicate that tooth loss may considerably increase the severity of tardive dyskinesia, a finding that suggests a possible role of preventive and prosthetic dentistry in the health care of patients at risk for this condition.

    May considerably increase the severity of tardive dyskinesia..
    June 1993
    http://www.thejpd.org/article/0022-3913(93)90285-V/pdf

  8. Thank you all for your interesting comments. I am glad to see that I am not alone with this problem. I guess that it seams to come with a variety of these drugs so it’s hard to know who to blame. One thing we do know is that it is not our fault.
    I have been lucky that I have had very little tooth ache in all of this. Makes me feel that either the nerve was attacked when I was zonked out by the drugs or that my pain receptors were not working?
    Since I am on benefits throughout this time, it has not cost me a penny! It is hard enough to deal with this without the worry of cost too.
    My September Hospital appointment has been cancelled and no sign of a new date.
    I did grind my teeth ( when I had them!) for a while and also had a twitch in my cheek, which I thought was because of my anxiety. Also I am forever thirsty so probably have had a dry mouth too. But I have to say that I didn’t get the impression from any of the dentists that the problem had anything to do with what was going on in my mouth. If I get this comment again from a dentist I will make a point of asking them too explain further if they can.

  9. https://en.wikipedia.org/wiki/Tooth_resorption

    Straight from the horse’s mouth – terrible pun – but a retired dentist, who also held a university post, suggests that ‘resorption’ might be significant – it’s a bit technical, to say the least but the link gives a detailed description of the process;

    in short: ‘Tooth resorption is a process by which all or part of a tooth structure is lost due to activation of the body’s innate capacity to remove mineralized tissue, as mediated via cells such as osteoclasts. Types include external resorption and internal resorption. It can be due to trauma, infection, or hyperplasia.’

    I guess this may be something to do with it – but not the whole story, as a good dentist would have recognised what was going on in my (and Shane’s) mouth. The idea that something is badly wrong with the body’s mechanisms around teeth – in addition to dry mouth – is interesting? Maybe a small piece of the jigsaw.

    I also thought (last night in bed) that olanzapine causes hyper-salivation, not dry mouth. My pillow was always soaking every morning with drool (yuk). Usually a nighttime thing but every so often I’d get uncontrollable rushes of saliva during the day – quite embarrassing as had to discretely find somewhere to spit and it was very disconcerting….

    • Sally

      This is an interesting possibility. If this were the case we should be able to link some of these drugs to osteoporosis.

      David

      • The possibility of a link with osteoporosis had crossed my mind when thinking through Shane’s teeth saga. He has suffered a lot with joint pains – knees, ankles and wrists mainly – throughout his time on psychiatric drugs. If I remember rightly, he had his knee x-rayed at one point. The diagnosis, as given by his GP, was of ‘wear and tear’, which, to me, seemed rather odd in a twenty something year old. At that time, the pain was so bad that he used a stick when walking outdoors as he was afraid of his knee just giving way and that he’d topple over. The pain seems less – or at least bothers him less – in the last couple of years.
        It seems that the more we look into these stories the more layers there possibly are before the tale is complete.

      • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977815/

        Took about 10 secs, if you google antipsychotics/osteoporosis. This link chosen rather quickly contains a load of info, again, which is incredibly technical (plus the amazingly untechnical old chestnut that schizophrenia itself causes osteoporosis – as well as diabetes and all the rest).
        If I’m correct – osteoporosis /bone thinning isn’t painful in itself – but makes fractures more likely. ..osteoarthritis is very painful – I’m getting seriously out of my depth however, trying to understand the connections. But there is a ton of evidence – of variable quality I guess – linking antipsychotics to osteoporosis. Bones, teeth – and some connection with hyperplasia – which seems to lead back to the blood and abnormal cell growth/behaviour….

        • Sally

          Wonderful. You should apply to become a GSK or Pfizer consultant. Its clear what needs to happen now. Every doctor needs to be informed about this and persuaded to get every patient on an AD or AP on a biphosphonate as well.

          David

          • Maybe I missed my true calling? there’s clearly an untapped market here for the bone drugs – but spotting links within the info, even though it’s horribly technical, is interesting – such as the fact that whatever causes resorption and osteoporosis is probably connected to prolactin production – hyperprolactaemia. Risperidone in particular causes women’s breasts to secrete milk – maybe men’s too – and disruption to prolactin production is linked to endometrial cancer – which I had.

            I wish I had time (and the skills) for a biochemistry degree to properly understand all this stuff. But a gut feeling tells me that all antipsychotics instantly affect blood, from the first pill – which could just be a root cause/trigger of a cascade of damage – including your teeth falling out – and immediate disruption to the hormone systems (lipids, insulin,etc).

  10. My word Sally – I couldn’t READ half of the information, never mind understand it. The only way, for me, was to scan through and pick out anything that I recognised! I notice that there is a paragraph on SSRIs and their connection to the problem as well as a link to antipsychotics. The only part that annoyed me was the continual reference to schizophrenia, as if these drugs were not been handed out for all sorts of minor ailments too.
    I understand that osteoporosis is not painful – it’s the idea of a twenty odd year old knee being painful due to ‘wear and tear’ suddenly upon use of these drugs that set me wondering what was going on and if the knee problem and teeth destruction were, in any way, linked.
    It’s interesting to note too that the article is dated 2013 – roughly the time when Shane was given the ‘ meds are to blame’ message by the dentists. I wonder if dentists had been directed to the content of this article? If so, had fracture clinics etc. also been informed? Could it be that the reason for medicating INCASE of osteoporosis is as a result of someone, somewhere sitting on this valuable information and, rather than sharing it, deciding on a lucrative,prevention programme? It is rather obvious that the more psychiatric drugs that are prescribed then the higher will be the number of cases of osteoporosis – if the content of this article is correct ( and, of course, if I’ve read it correctly!).

    • Sounds as if you did exactly as I did Mary – just noted things that jumped out – I didn’t understand any of the science at all, at all….! I wish I did. You’re absolutely correct that all the information about antipsychotics always relates to schizophrenia….I got so fed up explaining that I was given olanzapine as a ‘mood stabiliser’ I’ve given up. Thinking about it though – the number of people with a schizophrenia diagnosis is comparatively small to those with depression (even including all of us who were given a bipolar label en route). So – all the tens (hundreds?) of thousands of us who ended up on an AP as an ‘adjunct’ medication when we responded badly to ADs are lost in the figures…..clever stuff.

  11. I’ve just finished reading Monty Don’s excellent book of his BBC TV series from 2006, ‘Growing out of trouble.’ This describes how, with backing from the West Mercia Probation service, he tried to help a group of young drug addicts get off drugs or at least, lead more fulfilling lives, eat better, and bond with the reality of the uplifting effect of working with the soil, looking after animals, etc.

    In his book he describes some of the difficulties these young people deal with every day, in trying to get off heroin. And the thing that shook me most was the accounts of how they were all losing their teeth, sometimes seven at a time.

    I realise that Sally isn’t talking about ‘hard drugs’ in her comments, but it’s interesting that teeth once again seem to be the first things to be affected on heroin too, and then users get very thin because they just can’t chew or eat easily.

    The book is very interesting and beautifully written. So many addicts seem hooked after just one or two episodes of trying these drugs. Monty got to know them all really well, as do we from his account in the form of a diary, and he ends by saying how fond of them he has become. Only some got completely better lives again, but all tried hard in their own ways, and with sincerity.

    I just felt the ‘tooth’ issue was worth mentioning.

  12. Another point has just come to mind – this time regarding GPs and their knowledge of the osteoporosis link. Sometime, about two and a half years ago, Shane’s GP surgery became a little obsessed with blood tests for him. There seemed to be a slight liver problem, which cleared up between the taking of the first and second blood samples. There was also concern about his cholesterol levels.Following that, there was concern that his phosphorous levels were low which ( I think) it was feared would have a detrimental effect on his body’s absorption of vitamin D and could cause calcium deficiency. There was quite a fuss about it at that time and Shane was asked to make sure he drank plenty of milk before the next blood tests. (That was no problem at all – he drinks litres of the stuff!).
    I wonder if some article or other had been introduced – or a reminder of such – at that time? Whatever was behind it, no explanation was given of any connection to his medications (there wouldn’t be would there, since they were the ones who first put him on SSRIs!) – and neither was a follow-up blood test ever taken. This concern was way too late for his teeth in any case and as far as he’s aware, his bones are ok – so what was it that caused the sudden interest….and, even more surprisingly, the loss of interest that followed?

Leave a Reply