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‘While the study is interesting, there are only small numbers of patients included and, as the authors highlight, there are other contributory factors that could also influence failure in this group.’ The study was not able to rule out, for example, that it was patients’ depression itself — rather than the SSRIs — that was driving the outcomes of their implant surgery.
For instance, it could be that raised levels of the stress hormone cortisol in those with depression might help drive inflammation and gum disease.
Additionally, ‘the varied behavioural symptoms of depression also include low levels of motivation, which may impact on people’s abilities to maintain oral health, with a consequential increased risk of gum disease combined with the stimulation of inflammation through the cortisol stress response’, says Professor Durham.
In other words, low mood might contribute to a lack of motivation to care for their teeth.
Rhona Eskander, a dentist at the Chelsea Dental Clinic in London, suggests that if you experience bruxism and take antipsychotic medication, ‘you may need a night guard’.
This is not the first study to highlight how prescription medication can affect the outcome of dental treatment.
Bisphosphonates — used to treat osteoporosis (a condition in which the bones become more likely to break) as well as some types of cancer — can prevent the mouth from recovering properly from dental treatments that involve surgery, such as implants or gum therapy, says Alan Clarke, a dentist and clinical director at Paste Dental in Belfast.
Bisphosphonates, which are prescribed to one in ten post-menopausal women in the UK (according to a 2019 study in the journal Bone), slow the breakdown and reabsorption of old bone.
The problem for dental patients is that the drug accumulates at sites of high bone turnover, such as in the jaw, and can reduce bone blood supply.
If the patient’s treatment is not managed properly, the socket won’t heal after a tooth has been removed: the teeth may become loose, and the bone may even die off (a process known as necrosis), ‘with symptoms far more severe and lasting than the planned dental intervention’, says Alan Clarke.
‘For instance, someone maybe has tooth pain and elects to have the tooth removed. Yet if this is not managed correctly they could end up having necrosis of the jaw bone due to the bisphosphonate medication, and an oral surgeon could have to surgically remove a large section of jaw bone under a general anaesthetic.
‘Thus, the patient needs much more severe and radical treatment than an extraction for a sore tooth or to remove a small area of residual infection — all to treat the impact that the bisphosphonates had on the results of a usually routine dental treatment under local anaesthetic.’
If possible, patients who are taking bisphosphonates should have root canal treatment rather than having their tooth removed, adds Alan Clarke.
He cites advice given to dentists in a 2013 review of this medication-related problem, which was published in the Journal of Oral Biology and Craniofacial Research.
Patients may also require regular X-rays to check for dead tissue. In complex cases where surgery is required, a serum CTX test, which measures the rate of bone turnover, can be done to assess the level of risk before an operation.
Alan Clarke adds that, because bisphosphonates have a particularly long half-life, they can ‘affect healing many years after you have stopped taking the medication, depending on how long the previous course was’.
SSRIs can also cause teeth- grinding, which can put pressure on implants, said the researchers in the British Journal of Oral and Maxillofacial Surgery. The medication can alter levels of the brain chemical dopamine, which is involved in muscle control
‘As documented in the New England Journal of Medicine in 2007, bisphosphonates were measurable in patients up to eight years following on from active treatment with IV [intravenous] bisphosphonates,’ says Alan Clarke.
‘So my advice is always to share a full medical history with your dentist, even if you feel it is not relevant — it just might be.’
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