Oral Health in Individuals with Severe Mental Illness on Second-Generation Antipsychotics-A Scoping Review

Abstract

There has been a significant increase in antipsychotic usage, particularly belonging to second-generation antipsychotics (SGAs), in the management of severe mental illnesses (SMIs) over the past few decades, but their impact on oral health is unclear. This review evaluated the oral side effects of the SGAs used in managing SMIs. A PRISMA-guided scoping review was conducted, using predefined criteria and relevant word combination in Medline (PubMed), Embase, Scopus and Cochrane databases. Eligible studies were assessed for study type, population demographics, antipsychotic medication usage, oral diseases and conditions, and their outcomes. Primary outcomes were explicitly studied oral conditions or diseases, and secondary outcomes were broader oral or general "treatment-emergent adverse effects." Twelve studies met the inclusion criteria for the primary outcomes and 13 for the secondary outcomes. The most reported primary outcomes were salivary gland dysfunction (hypofunction, three studies; hypersalivation, two studies), dental caries (positive association, three studies; no association, one study), and periodontal disease (five studies). Secondary outcomes included dysgeusia and oral hypoesthesia (six studies). SGAs significantly compromise oral health, particularly through salivary gland and sensory dysfunction, highlighting the need for up-to-date guidelines on routine oral screening and preventive care.