Antipsychotic medications linked to increased risk of oral health problems

A research group in the Department of Pharmacology of the University of the Basque Country has investigated the adverse reactions that antipsychotics can cause in the mouth. The study was based on data from the European pharmacovigilance database EudraVigilance and revealed that the most common problems are related to salivary flow disorders (such as excessive salivation and dry mouth), oral inflammation and tooth loss.

Individuals with mental illness are known to be at increased risk of systemic diseases, and neuropsychiatric disorders are associated with poor oral and dental health. Recent years, however, have seen a growing interest in paying attention to the oral and dental situation of people with mental health disorders, since the relationship between oral health and general physical and mental health is very important. Furthermore, although the side effects of antipsychotic drugs (drugs used to treat schizophrenia, in particular) have been extensively studied, their effect on the mouth has not.

Researchers from the Department of Pharmacology of the University of the Basque Country (EHU) have been studying the oral health of people with schizophrenia.

So using the European EudraVigilance pharmacovigilance database, we analysed 5,633 reports. These reports raised suspicions about the harmful effects of antipsychotic drugs."

Nerea Jauregizar, EHU researcher

Research has shown that antipsychotics are strongly associated with adverse oral effects: "Those related to the alteration of salivary flow, such as excessive salivation and dry mouth, were reported the most, according to the drug taken," said Teresa Morera, an EHU lecturer. "But in addition to that, cavities, tooth loss, inflammation of the salivary glands and tongue, etc. are also related to certain antipsychotics."

In the EudraVigilance database suspected side effects are also reported by health professionals (doctors, dentists, pharmacists, nurses, etc.), the pharmaceutical industry, and even patients. "In the research, we detected potential signs of risk. We saw that the reporting of adverse reactions in the mouth is higher with antipsychotics compared with other drugs," explained the researcher Leire Urien. We found that the probability of reporting adverse reactions is higher for antipsychotic drugs."

The disproportion observed in the European database revealed that "antipsychotic drugs are associated with adverse oral reactions. But that does not establish a causal relationship. It means that patients treated with antipsychotic drugs have a higher risk of developing oral conditions, and many of these diseases are likely to be associated with the adverse effects these drugs have on oral health," she said. The researchers also pointed out that they had not found differences according to gender.

Many factors exert an influence

"Oral health is known to be associated with a range of factors, and some drugs exert an effect. However, it is not easy to establish a direct relationship, because patients with mental health disorders take various drugs, not only antipsychotics, but also antidepressants, sleeping pills, drugs for other systemic diseases, etc.", explained the EHU research team. Jauregizar also pointed out that people with mental health disorders generally do not have healthy oral hygiene habits and are substance abusers (drugs, tobacco, etc.). In addition, these patients experience difficulties when accessing oral health care.

The researchers have proposed some general recommendations for oral health care for patients with mental health problems: "It is very important to systematically check the oral health of patients and help them improve. People with schizophrenia are often stigmatized; if they are helped to take care of their mouths, this will help them improve their life quality. It is essential to develop preventive measures: firstly, to ensure good oral hygiene and good habits, and secondly, it is very important to ensure collaboration among the health professionals who treat them; in this case, psychiatrists should be in contact with dentists."

Additional information

This research was part of the PhD thesis by Leire Urien, a researcher and lecturer in the Department of Pharmacology of the University of the Basque Country. In her thesis, Dr Urien studied the oral health of people with schizophrenia; her supervisors were the researchers and lecturers Nerea Jauregizar and Teresa Morera at the EHU's Faculty of Medicine and Nursing.

Members of the Pharmacovigilance Unit of the Basque Country (Galdakao Usansolo Hospital) also participated in the research.