Implications for Anxiety and Depression Medications on Periodontal Disease Progression and Therapy

Stress and depression have been associated with negative treatment outcomes in patients with periodontal disease.^4,5,26 Baseline levels of depression have been found to be predictive of the proportion of residual periodontal probing depths and tooth loss between 1 and 5 years post-treatment.⁷⁸ In patients receiving periodontal maintenance, occupational stress was associated with greater clinical attachment loss.⁷⁹ These studies indicate that psychosocial disorders should be identified and addressed prior to and during therapy to insure optimal treatment results.

Recent studies have indicated that antidepressant medications, particularly SSRIs and SNRIs, were associated with reduced levels of bleeding on probing (BOP) and clinical attachment loss in patients with depression and periodontitis.^80,81 Furthermore, animal studies indicate that administration of antidepressant medications resulted in an amelioration of bone loss in animals with induced periodontitis exposed to stressful stimuli that made it approximately equivalent to those who were not exposed to the stressor.^82,83 Given the overall underreporting, under-diagnosis, and under-treatement of anxiety disorders and depression, co-management of individuals with periodontitis and depression/anxiety by mental healthcare professionals and the dental team can insure best outcomes for patients.