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Management of Patients with Chronic Diseases

Course Number: 567


A mood disorder which affects how a person feels, thinks, and handles daily activities.44 Clinical signs and symptoms are summarized in Figure 8. These signs and symptoms must be present for at least 2 weeks to signal the presence of depression (also called major depressive disorder or clinical depression).

Figure 8. Signs and Symptoms of Depression.

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment44

Epidemiology and Etiology

Mood disorders are the 3rd most common cause of hospitalization in the US for people age 18 to 44 years old.45 Depression is one of the most common mood disorders in the United States.44,45It is thought to be caused by a combination of genetic, biological, environmental, and psychological factors.44 It may present itself at any age, but often it begins in adulthood. Risk factors include high levels of anxiety as a child, a personal or family history of depression, being diagnosed with a serious medical condition or medications, and major life changes, trauma, or stress.44 In children, depression often presents as irritability.44 Serious mental illness decreases life expectancy by 25 years.45

Patient Management and Oral Health Considerations for Depression

Patients experiencing depression may not recognize their oral hygiene needs or they may not care about their oral health. This can lead to poor oral self-care, fewer dental appointments, and ultimately oral health problems.46 Medications used to treat depression can also contribute to oral health problems (Figure 9).20,47 Antidepressants have been associated with bruxism and TMD.46

Antidepressants, antihistamines, anticholinergics, antihypertensives, and antipsychotics are known to alter salivary gland function resulting in xerostomia.20,47 A high percentage of patients taking these medications experience dry mouth. This leads to many of the other problems listed in Figure 9 such as dental caries, taste distortion, chewing, swallowing, and oral infection.

Figure 9. Oral Side Effects from Medications Prescribed to Treat Depression.42,46

  • Aphthous stomatitis
  • Bruxism
  • Burning mouth syndrome
  • Candidiasis or candida albicans
  • Cheilitis
  • Dental caries
  • Distortion with the sense of taste
  • Dysphagia
  • Facial, tongue or oral edema
  • Gingival hyperplasia
  • Glossitis
  • Halitosis
  • Mucositis and stomatitis
  • Oral ulcers
  • Periodontitis
  • Periodontal abscesses
  • Sialadenitis
  • Sinusitis
  • Temporomandibular joint disorder (TMD)
  • Toothache
  • Ulcerative gingivitis
  • Xerostomia