Bipolar & Dental Health

Bipolar disorder is a psychiatric illness, formerly known as manic-depressive disorder, that causes spells of elated and depressed mood swings with intervals of normal moods.

Their most common complaint is dry mouth and loss of taste. Those with the highest amount of decay and gum disease had the longest history of lithium use and the greatest number of hospital admissions for dipolar disorder.

People who have Bipolar disorder are at the high risk of developing:

Cause	Oral symptoms
Manic Phase	Toothbrush/dental floss scratches and cuts on gum tissue Toothbrush abrasion of teeth
Depressive Phase	Disregard of oral care High decay, missing and filled teeth Severe periodontal disease due to neglect, increase in smoking, changed immune response
Medications Effects	Dry mouth causing them to drink large quantities of sugared drinks Bruxism Gum disease Intense craving for foods high in sugar High Lactobacillus count Swelling /infections of mouth and tongue

This disorder may make the individual uncooperative and irritable during dental treatment, appear unappreciative and have numerous complaints that are inconsistent with findings.

It is important to:

	Provide a complete medical/dental history
	Give permission for the dentist to consult with psychiatrist about mental status, medication regiment, drug and alcohol abuse history
	Preventive dental education is of the highest important to obtain and follow
	Artificial salivary products should be prescribed
	Scaling and root planing will be needed for gum disease
	Cavities will need to be controlled
	Restorative
	Good anesthesia levels must be obtained before procedures are performed
	Dental exams and cleaning with fluoride should be done every 3 months
	Cosmetic dentistry that could enhance self esteem should be considered
	Beware of drug interactions

Treatment

Important factors to provide is education, trust and respect.

Aggressive preventive dental education program that includes the use of artificial salivary products, antiseptic mouthwash and daily fluoride mouth rinses.

February 06, 2008

General Dentistry Sep/Oct 2004 and Impact April 2005 pg25-27.

*Bipolar 1 Disorder, Psychopathology, medical management and dental implications; Arthur Friedlander, Ida Friedlander, Stephen Marder; JADA, Vol 133 Sept 2002 pgs 1209-1217

Resources

Here are some Web sites for more information about mental illness:

• National Institute of Mental Health

• Rethink (formerly the National Schizophrenia Fellowship), www.rethink.org

• National Mental Health Association, www.nmha.org

• Depression and Bipolar Support Alliance, www.ndmda.org

• Anxiety Disorders Association of America, www.adaa.org

• National Mental Health Consumer Self Help Clearinghouse, www.mhselfhelp.org