Journal of Clinical Case Reports

Aims:This case report aims to increase the awareness of the psychiatrist and dentist about the necessity of regular dental evaluation of the patients on antipsychotics, in order to reduce the incidence of periodontal disease.
Presentation of case: A 32 year old female patient suffering from schizophrenia, and on antipsychotic medications, since 11 years of age presented with complaint of pain and mobility in upper front teeth. Clinical and radiographic examination establishes severe generalised periodontitis associated with generalised gingival enlargement. Dexa test suggested reduced BMD; hormonal investigation implicates severe hyperprolactinaemia with no other hormonal abnormality. Periodontal management, withdrawal of Risperidone and dose reduction of Amisulpride, vitamin D, calcium supplements and Alendronate has been advised. Patient is on regular follow-up.
Discussion: Antipsychotics are the mainstay in the treatment of schizophrenia. Use of even atypical antipsychotics like Risperidone and Amisulpride has been associated with statistically significant decrease in the bone mineral density (BMD). Periodontitis is an inflammatory disease associated with progressive loss of alveolar lone resulting in tooth loss. There is greater propensity to lose alveolar bone, due to antipsychotic induced hyperprolactinaemia, in schizophrenia patients.
Conclusion: Regular monitoring of prolactin levels and dental screening programs are pre-requisite for patients on antipsychotics to prevent them from periodontal bone loss.