Dental management of patients with psychological and psychiatric disorders


- this is image in implant placement procedure, so memorable moment -



Approximately 15 % of the population have a significant psychological disorder and approximately 2% have a major psychiatric disorder. If these are not managed, they can have serious individual and societal consequences. Pharmacological treatment is often used in the management of psychological and psychiatric disorders.
Drugs commonly used in psychiatric disorders
* antidepressants :
+ selective serotonin reuptake inhibitors ( SSRIs) : citalopram, escitalopram, fluoxetine, fluvoxamin, paroxetine, setraline.
+ tricyclic antidepressants ( TCAs) : amitriptyline, dothiepin, doxepin
+ monoamine oxidase inhibitors ( MAOIs) : moclobemid, phenelzine
+ serotonin and noradrenalin reuptake inhibitors ( SNRIs): venlafaxine, duloxethine
+ others : mirtazapine, reboxetine
* Mood stabilisers ( used in bipolar disorder) :
+ carbamazepine, lamotrigine, lithium, sodim valproate.
+ first generation antipsychotics: chlopromazine, droperidol, flupenthixol, fluphenazine, haloperidol, pericyazine, trfluoperazine, zuclopenthixol
+ second generation antipsychotics : amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone
* Psychostimulants: dexamphetamine, methylphenidate, modafinil
* anxiolytics and hypnotics :
+ benzodiazepines: diazepam, telezepam
+ others : zolpidem, zopiclone
* drugs used in substance use disorders :
+ buprenorphine, methadone, naltrexone
* drugs used in dementia:
+ cholinesterase inhibitors : donepezil, galantamine, rivastigmin
+ others : memantine
Dental issues:
Drugs commonly used in dentistry rarely have significant interactions with psychotrophic drugs.Local anaesthetics containing adrenalin are not contraindicated with triclyc antidepressants( TCAs) or selective serotonine reuptake inhibitors ( SSRIs), but should be avoided in patients taking monoamine oxidase inhibitors ( MAOIs).
Dentist and their staff should be aware of the psychological status of their patients as this can affect the dental treatment plan and outcomes. Psychological status should be determined by taking a thorough medical history. The patient's medication list may be helpful in determining their underlying mental health condition.
Examples:
A patients who has body dysmorphic disorder( characterized by a preoccupation with imagined or slight defects in physical appearance) may at first seem suitable for an aesthetic dental procedure. However, no matter how much the appearance of their teeth and jaws improve, they will be never be satisfied.
A patient who is markedly is markedly thin with marked erosion of the enamel surface of the teeth may have an eating disorder.
Patients with anxiety or phobic states can be difficult to manage. Many do not present to dentist for routine treatment and seek treatment only when a painful emergency occurs.
Routine sedatives may be ineffective as these patients may have developed a tolerance to them. General anaesthesia or specialist referral may be required.
Drugs dependent and drug seeking patients are common in general dental practice.
Drug dependent and drug seeking patients may presents to a dental practice. Be suspicious of any patients who demands analgesic drugs and exhibits a good level of knowledge or preference for a specific opioid.
Do not initiate treatment in the absence of demonstrable disease. At most, offer a small amount of analgesic and advise the patient the patient to consult their medical practitioner.

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