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Author: Admin | 2025-04-28
Home > Features > Oral Health > 5 Things to Know About Psychotropic Medications and Dry Mouth Many psychotropic drugs cause dry mouth, most commonly due to anticholinergic effects. Xerostomia a common issue in dental practice, affecting about 1 in 4-5 adults.1 It can cause a range of signs and symptoms, from a mild sensation of dryness and stickiness to more serious effects such as difficulties with chewing, swallowing, and speaking.2 If prolonged, xerostomia can lead to tooth decay, periodontal disease, and tooth loss, as well as an increased risk of mouth sores, recurrent oral candidiasis and angular cheilitis. Dentures can be uncomfortable or impossible to wear, as well as cause painful mouth sores by rubbing against the gums.3Xerostomia is associated with many medical conditions, radiation therapy for head and neck cancers, and medications. Many psychotropic drugs cause dry mouth as a side effect (see Table 1). These medications are used not just for mental health conditions (such as depression, anxiety, schizophrenia, bipolar affective disorder, and attention deficit hyperactivity disorder (ADHD)) but also for non-psychiatric reasons such as neuropathic pain, insomnia, and migraine prophylaxis.Table 1: Psychotropic drugs with dry mouth as a side effect1,16,18,19,20,21,22,23,24,25, 26,28Table 1. * includes off-label uses* includes off-label uses.* includes off-label usesSaliva production is controlled by the autonomic nervous system (ANS). Parasympathetic nerves release acetylcholine, leading to the production of copious amounts of watery saliva. Sympathetic activation of salivary glands also produces saliva, but in smaller amounts and more viscous in quality. The parasympathetic division tends to predominate under resting conditions. When stressed or anxious, the sympathetic nervous system predominates, leading to a change in the composition of saliva, leading to the sensation of dry mouth. Drugs with sympathomimetic activity act in the same way (e.g. amphetamine-like drugs for ADHD and bupropion used for depression or smoking cessation).However, most psychotropic drugs cause dry mouth by interfering with the parasympathetic nervous system. Antimuscarinic drugs bind to, and block, muscarinic cholinergic receptors in the salivary glands, leading to reduced saliva output and dry mouth. Other anticholinergic side effects include dry eyes, dry skin, flushing, urinary retention, constipation, blurred vision, photophobia, dizziness and cognitive impairment.Dry mouth is one of the first anticholinergic side effects to occur, along with dry eyes and dry skin. Unfortunately, anticholinergic symptoms do not go away with time. The frequency and severity of dry mouth depends on the anticholinergic activity of the specific drug, the dose, and the number of drugs being taken. Hundreds of drugs have anticholinergic side effects. Among the most highly anticholinergic are tricyclic antidepressants, drugs for overactive bladder, and first-generation antihistamines.There are various scales which can help to quantify the “anticholinergic burden,” such as the Anticholinergic Drug Scale, the Anticholinergic Cognitive
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