- Especially selective serotonin reuptake inhibitors increased the risk of failure
- A study conducted in Spain focused specifically on the effect on the roots of the teeth.
Can prescription drugs affect the outcome of dental implant surgery? This is a question highlighted in a recent study by Spanish dentists.
They found that people who had taken antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) at the time of surgery and for at least a year, had a 4.5-fold higher risk of implant failure. Did.
The 170 patients in the study were taking the most commonly prescribed SSRIs in the UK, including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline.
A dental implant is a replacement tooth root that uses a metal screw that is placed directly into the jawbone to provide a base on which a denture can be attached.
They are not typically offered by the NHS and can cost thousands of dollars to do privately.
A “failed” implant is defined as dislodgment or migration of the implant, or development of bone loss, pain, or pus formation.
Researchers at Madrid’s Complutense University have suggested that SSRIs can affect bone metabolism, the formation and breakdown of bone.
Normally, the body places the new bone directly onto the surface of the implant and anchors it. This is a process called osseointegration. However, this does not occur with SSRIs, resulting in the implant not integrating with the bone.
The drug can also cause bruxism and put pressure on implants, say researchers in the British Journal of Oral and Maxillofacial Surgery. This drug can alter levels of the brain chemical dopamine, which is involved in muscle control.
Antipsychotics prescribed for bipolar disorder, severe depression, and schizophrenia can also cause teeth grinding, which can cause problems with dental implants.
In a 2019 Journal Australian Prescriber report, Geraldine Moses, consultant pharmacist at the Australian Dental Association, wrote: [i.e. teeth-grinding] It is an underrecognized adverse drug reaction, particularly associated with the use of antipsychotics and SSRIs.
So how much should people worry if they are taking these prescription drugs and have had or plan to have dental implants?
Professor Justin Durham, Chief Scientific Advisor to the British Dental Association, called the findings “interesting”, but more research is needed before definitive conclusions can be drawn and clinical guidelines will be developed based on the findings of the study. said it would not change.
“The mechanisms by which these antidepressants may affect the attachment of teeth and implants to oral bone are complex and not yet fully investigated and understood.
“While this study is interesting, the number of patients included was very small and, as the authors emphasize, there are other factors that may have contributed to the failure of this group.” In this study, for example, we could not rule out the possibility that it was the patient’s depression itself, rather than the SSRI, that was driving the outcome of the implant surgery.
For example, elevated levels of the stress hormone cortisol in depressed patients can lead to inflammation and gum disease.
Furthermore, “Various behavioral symptoms of depression also include decreased motivation, which can affect people’s ability to maintain oral health, resulting in increased inflammation due to the cortisol stress response.” combined with the stimulation of , may increase the risk of periodontal disease, ”said the professor. Durham.
In other words, low mood can contribute to a lack of motivation to care for your teeth.
“You may need a night guard,” suggests dentist Lorna Eskander of Chelsea Dental Clinic in London, if you’ve experienced bruxism and are taking antipsychotics.
This is not the first study to highlight how prescription drugs affect dental outcomes.
Bisphosphonates, used to treat osteoporosis (a condition that makes bones fragile) and some cancers, can prevent the mouth from properly recovering from surgical dental procedures such as implants and gum treatments. says Alan. Clark, Dentist and Clinical Director at his Paste Dental in Belfast, said:
Bisphosphonates, prescribed to 1 in 10 postmenopausal women in the UK (according to a 2019 study in the journal Bone), slow the breakdown and resorption of old bone.
A problem for dental patients is that the drug can accumulate in areas of high bone turnover, such as the jaw, reducing blood supply to the bone.
If the patient’s treatment is not properly managed, the socket will not heal after tooth extraction: the tooth may loosen and even die of bone (a process known as necrosis). It lasts longer than any planned dental intervention,” says Alan Clark.
“For example, someone has a toothache and chooses to have the tooth extracted. may require surgical removal of most of the jawbone under general anesthesia.
“Patients are therefore advised to remove painful tooth extractions or small areas of residual infection to treat the impact bisphosphonates have had on the outcome of routine routine dental procedures under local anesthesia. It is much more serious and requires radical treatment than .’
When possible, patients taking bisphosphonates should have root canal treatment rather than tooth extraction, added Alan Clarke.
He cites advice given to dentists in a 2013 review of this medication-related problem, published in the Journal of Oral Biology and Craniofacial Research.
Patients may also need regular x-rays to check for dead tissue. A serum CTX test can be performed to measure
Alan Clark adds that bisphosphonates have particularly long half-lives, which “may affect healing many years after stopping the drug, depending on how long the previous course has been.” I’m here.
“As described in the 2007 New England Journal of Medicine, bisphosphonates were measurable in patients up to 8 years after active IV treatment. [intravenous] bisphosphonates,” says Alan Clarke.
“So my advice is to share a complete medical history with your dentist, even if it doesn’t feel relevant.
“These drugs do not affect restorative dentistry such as fillings, root canals, crowns, or veneers. [any ‘restorative’ work involves fixing the teeth you have and keeping them in place].’
Another class of drugs that can cause problems are anticoagulants. “Drugs such as clopidogrel are widely used to reduce the chance of heart disease and stroke in high-risk people.
“A risk for dental patients is excessive bleeding when undergoing procedures such as tooth extractions or dental implants. can be done.
“But if the dentist knows that the patient is taking anticoagulants, they can contact the doctor to temporarily stop the medication and perform surgery.”
He adds: “As long as the patient is aware that they may bleed longer than usual, it’s fine most of the time.
“But we prefer to do these procedures in the morning so that we can monitor them before sending them home if necessary.”
Dr. Palmer adds:
Immunosuppressive drugs that help “calm down” the immune system and are used to treat autoimmune diseases such as rheumatoid arthritis and Crohn’s disease may also affect treatment.
Because they compromise the body’s normal healing and defense mechanisms, they are often referred to as “surgical site [for dental implants, for instance] It may not heal effectively, and as such it may be at risk,” says Richard Moore, a consultant and clinical lecturer in oral surgery at the University of Leeds. They are more susceptible to integration failures and overall implant failures.”
As a simple rule of thumb, before any oral surgery involving fillings, when your dentist asks questions at the start of your appointment, ‘Tell us about your medical history and medications,’ adds Richard Moore.
“This is very important for all dental treatments, but it is also very important for overall care by dentists,” he says.
