| Dental Implications of Schizophrenia .
Schizophrenia is a psychiatric illness characterized
by:
 | thought disturbances |
| bizarre behaviors |
| cognitive impairments |
that may diminish a person's abilities in the areas of
social relations, school or work and self-care. The onset of the
disorder typically occurs between the late teens and mid-30s.
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Advanced dental disease
is seen frequently in patients
with schizophrenia for several reasons:
| the disease impairs ability to plan and perform oral
hygiene procedures |
| some of the antipsychotic medications
have adverse effects such as xerostomia or dry mouth |
| limited access to treatment because of lack of
financial resources and adequate number of dentists comfortable in
providing care. |
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A full range of services
can be provided that can enhance self-esteem and can contribute to the
management of this condition through effective communicate
with:
| Patient-complications from medications may result
in dry mouth causing gum
disease and rapid caries progression which lead to an extremely high
requirement for periodontal
treatment, fillings, and extractions,
TMD and impaired gag reflex |
| Treating psychiatrist to obtain:
 | psychological statue. |
| medication regimen. |
| ability to give valid consent for
treatment. |
| medicolegal competence to sign a consent form
for proposed care. |
| ability to participate in treatment plan in
order to perform preventive hygiene procedures. |
| medication interactions and CNS involvement to avoid
excessive CNS depression, hypotension or respiratory depression. |
| Clozapine patients need to have the most recent WBC
count evaluated to determine bone marrow suppression which
is a total WBC count of less than 3,000 per mm. |
|
| Family members who serve as caregivers need
to be educated on oral hygiene care. |
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In addition, dental treatment can be modified
because of:
| impaired ability to think logically. |
| local and systemic effects of psychiatric
medications. |
| adverse interactions between these drugs and
medications used in dentistry. * |
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Dental Management Considerations
1. Preventive dental education need to be done:
| before a large mirror. |
| oral instructions need to be shown and demonstrated
. |
| colorful posters are that effectively describe proper
tooth brushing, flossing and mouthrinses can be used. |
2. Fixed prosthodontic prostheses are to be used
even in patients with compromised oral hygiene and are preferred to
removable appliance that may be misplaced or even ingested.
3. In dental treatment the airway should be diligently protected
because of the patients propensity to have an impaired gag
reflex. Shorter appointments may be necessary.
4. They need 3 month intervals for exams,
cleanings and
application of fluoride gel.
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* Friedlander AH, Marder S R The
Psychopathology, Medical Management and Dental Implications of
Schizophrenia JADA Vol. 133, pg 603-609, May 2002
Bipolar
and Dental Health
Depression
and Dental Health
February 06, 2008 |
