article · BMC Oral Health
Periodontal disease presents a major oral health challenge that can lead to tooth loss and reduced quality of life. Schizophrenic patients face an elevated risk of gum disease, partly influenced by their psychiatric medications. A retrospective cohort study examined sixty-four patients divided into three cohorts: those taking prolactin-inducing antipsychotics for at least one year, those taking prolactin-sparing antipsychotics for at least one year, and untreated or newly diagnosed patients. Assessments covered periodontal metrics, bone mineral density, and serum prolactin levels. Patients taking prolactin-inducing medications exhibited significantly higher periodontal pocket depths, clinical attachment loss, and serum prolactin levels than the other two groups. Furthermore, significant variations in bone mineral density emerged across the groups. A direct relationship connected serum prolactin levels with periodontal pocket depth, attachment loss, and bone mineral density, indicating heightened periodontal risk associated with prolactin-elevating treatments.
Schizophrenia treatment often requires long-term medication that can adversely affect oral health and bone density. Understanding that prolactin-inducing antipsychotics correlate with increased gum disease severity can help dental professionals and psychiatrists recognise side effects sooner. This awareness encourages integrated healthcare approaches to monitor oral hygiene and bone health, potentially preventing severe tooth loss and preserving overall well-being for vulnerable patient groups.
This early-stage observational research highlights clinical risks rather than a ready commercial product. The findings could inform future clinical guidelines or diagnostic screening protocols used by psychiatrists and dental practitioners to monitor at-risk patients. Because the abstract notes that further long-term, large-sample interventional trials are required before definitive clinical guidelines can be established, the practical implementation of formal protocols remains at an early stage of development.
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BACKGROUND: Periodontal disease is a major health problem that results in tooth loss and thus affects oral health, which affects quality of life. In particular, schizophrenic patients are at higher risk for periodontal disease due to several factors, including the effect of antipsychotic medications received by those patients. Accordingly, the aim of the present cohort retrospective study is to explore the effect of antipsychotics on periodontal health and the possible effect of antipsychotic-induced hyperprolactinemia as a risk factor for periodontal disease progression in schizophrenic patients. METHODS AND OUTCOMES: The study population consisted of three groups: Group A (n = 21): schizophrenic patients that have been taking "prolactin-inducing" antipsychotics for at least 1 year; Group B (n = 21): schizophrenic patients who have been taking "prolactin-sparing" antipsychotics for at least 1 year; and Group C (n = 22): newly diagnosed schizophrenic patients and/or patients who did not receive any psychiatric treatment for at least 1 year. The study groups underwent assessment of periodontal conditions in terms of pocket depth (PD), clinical attachment loss (CAL), gingival recession, tooth mobility, and bleeding on probing (BOP). Also, bone mineral density was evaluated using DEXA scans, and the serum prolactin level was measured by automated immunoassay. RESULTS: Results revealed a statistically significant difference in PD, CAL, and serum prolactin levels (P ≤ 0.001, P = 0.001, and P ≤ 0.001, respectively) among the 3 study groups. For both PD and CAL measurements, group A has shown significantly higher values than both groups B and C, whereas there was no statistically significant difference between the values of groups C and B. Concerning serum prolactin levels, group A had significantly higher values than groups B and C (P ≤ 0.001 and P ≤ 0.001 respectively). There was a statistically significant difference (P ≤ 0.001) between the 3 study groups in terms of bone mineral density. Moreover, there was a statistically significant direct relation between serum prolactin level and other parameters including clinical attachment loss, pocket depth measurements and bone mineral density. CONCLUSION: According to our results, it could be concluded that all antipsychotics contribute to the progression of periodontal disease, with a higher risk for prolactin-inducing antipsychotics. However, further long term, large sampled, interventional and controlled studies are required to reach definitive guidelines to allow clinicians properly manage this group of patients.
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DOI: 10.1186/s12903-023-03404-1
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