We’re living through what many experts are calling a ‘global mental health crisis’ – and it’s easy to see why. Recent times have been full of monumental change, not only setting the stage for global events such as the pandemic, but also smaller, ongoing problems such as the cost-of-living crisis. With so much pressure and stress, it’s little surprise that estimates believe around 7% of the global population has depression – a figure that equates to millions of individuals.[i]
As professionals, we’re well aware of what depression can mean for patients’ oral health. For instance, it’s been commonly recorded that individuals with depression may eat poorly or fail to properly perform oral hygiene routines, as well as not attend dental care appointments.[ii] However, could drugs developed to manage depression also impact oral health?
Antidepressants: how widespread is their use?
Current figures suggest that over 8.3 million people in the UK currently take antidepressants. This number is on the rise, and prescriptions for this type of medication increased substantially (by 5%) over the course of 2021 and 2022.[iii] These figures could be interpreted as either negative or positive, depending on the way they are viewed. For instance, some may take this increasing number as proof that more people are suffering from depression. Others, however, may interpret this as a sign that more people are seeking help for a condition they may have been suffering from for a long time. Either way, it’s clear that antidepressants are becoming far more commonly used among the general population.
What’s concerning about this, from an oral health perspective, is that new research from a team at the University of Buffalo has found that use of antidepressants could lead to significantly increased chances of dental implant failure. In fact, the study found that the risk of dental implant failure doubles for every year of antidepressant drug use, meaning that those who have been on these medications for a long time are likely to face high failure rates.[iv] The reasoning behind this is multi-faceted. Common side effects of antidepressant medications include bruxism and dry mouth, both of which could interfere with a dental implant’s healing process. Furthermore, the study also revealed that antidepressant drugs can decrease regulation of the bone metabolism – an instrumental part of the healing process after dental implant placement.
Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant drug that works by increasing serotonin levels in the brain, are one of the most common types of antidepressant prescribed.[v] Unfortunately, they are also the drugs that have been found to negatively affect bone density around the whole body, including bones essential to the success of dental implant therapy. But what does this mean for the future?
A potential problem on the horizon
Dental implant therapy is becoming more and more popular. As the UK population continues to age (the median age has risen from 37.9 in 2001 to 40.7 in 2022)[vi] the demand for dental implant procedures has increased alongside. While there are no firm figures about the number of dental implants being placed each year in the UK, back in 2012 the number was believed to be around 120,000[vii] – and this has likely increased within the last decade.
So, what this data suggests is that there are challenging times ahead. The number of patients seeking dental implant therapy who are also on antidepressant medication is only going to increase, implying that failure rates will also be on the rise unless proper precautions are taken.
Really, what this comes down to, is making sure that patients are open and honest with us about any medications they are on. It’s important we broach the topic with compassion – there’s still stigma attached to mental illnesses such as depression which could lead to individuals being reluctant about sharing which medications they’re on. We need to outline why this is important for us to know, explaining that these medications can cause complications. This is especially vital considering that dental implant surgery is invasive and a significant financial outlay for these individuals – no one wants to see their dental implant fail.
There’s always a solution
While this is concerning news, we have to remember that antidepressant use doesn’t automatically mean implant failure. If patients on these drugs are informed of the possible complications, we’ve done our part to ensure that they are aware of the increased chance of failure rates. From this point, the treatment journey will depend on what decisions they make, whether that’s coming off the medications (if plausible) or exploring alternative dental treatment options. The perennial question remains is it better to save a tooth with root canal treatment or extract it but replace it with an implant that may fail?
There is likely a solution out there – dentistry evolves so rapidly that once this becomes a more pressing problem, there will be those dedicated to solve it. Until then, as long as we’re open and honest, we can manage this situation as it develops.
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[i] The Checkup. Depression Statistics 2022. Link: https://www.singlecare.com/blog/news/depression-statistics/ [Last accessed January 23].
[ii] Skośkiewicz-Malinowska, K. et al. Oral health condition and occurrence of depression in the elderly. Medicine (Baltimore). 2018 Oct; 97(41): e12490.
[iv] Healthnews. Can Antidepressant Medication Lead to Dental Implant Failure? Link: https://healthnews.com/family-health/dental-and-oral-health/can-antidepressant-medication-lead-to-dental-implant-failure/ [Last accessed February 23].
[v] NHS. Overview – Selective serotonin reuptake inhibitors (SSRIs). Link: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/ [Last accessed February 23].
[vi] Statista. Median age of the population of the United Kingdom from 2001 to 2021. Link: https://www.statista.com/statistics/281288/median-age-of-the-population-of-the-uk/ [Last accessed February 2023].
[vii] Dentistry. The sky’s the limit with implant dentistry. Link: https://dentistry.co.uk/2018/02/20/skys-limit-implant-dentistry/#:~:text=Implant%20dentistry%20has%20been%20on,of%20Dental%20Implantology%2C%202012). [Last accessed February 23].