Dietary and Other Caries Risk Factors Associated with Psychiatric Medications

Objectives: The purpose of this study is to evaluate caries increments in a psychiatric subgroup of participants taking known xerogenic medications and to examine the associated dietary and other risk factors. Methods: A single calibrated examiner determined caries at the baseline visit, and at a 9 month follow-up visit on 684 Boston-area volunteers aged 40-80 taking a xerogenic medication with demonstrated salivary hypofunction. The psychiatric subgroup (n= 173) had a mean unstimulated salivary flow = 0.056ml/min, a mean age of 60, 65% female, 89.6% Caucasian , 59% under $35,000 and mean of 24 teeth. Caries increments were determined by changes from sound to carious, sound to filled, and filled to recurrent. Reversals were subtracted as decrements. A modified Block food frequency questionnaire was administered. Results: The mean annualized increment was 0.947± 2.910. Using a stepwise logistic regression model that controlled for baseline caries, consumption of sugar (p≤0.038), smoking (p≤0.009) and psychiatric medications use (p≤0.003), were all significantly associated with caries incidence. Number of teeth, flossing, brushing, dental visits and income were also included in the model and found not to be significant. The types of the sugar consumed by volunteers on psychiatric medications and other medications were compared using an 2-tailed independent t-test. The total sugar intake of the psychiatric patients was significantly higher (p≤.020). These participants also consumed significantly more liquid sugar (p≤.024) and solid sugar (p≤.025). Semi-solid sugars, sticky sugar, slowly-dissolving sugar consumption was not found to be significantly different. Conclusion: Elderly volunteers taking psychiatric medications are at increased risk for developing dental caries despite good hygiene habits and regular dental visit. Their increased risk for caries may be explained partially by an increased consumption of sugar to soothe dry mouth and increased smoking. Longer longitudinal studies are necessary to establish a relationship. (Funded by Procter and Gamble)