Impact of major depressive disorder and later life depression on oral health
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In 2000, the World Health Organisation (WHO) ranked Major Depressive Disorder (MDD) as the fourth most common cause of disability and premature death worldwide. Within the next five years, it is predicted to become second only to ischaemic heart disease. With up to 12% of men and 24% of women experiencing MDD in their lifetime, it is most important the condition and its oral implications are understood. MDD is defined as a psychiatric illness with a minimum duration of two weeks. During this time sufferers experience anhedonia which is defined as loss of pleasure or interest in activities previously enjoyed, dysphoria whereby demonstrating feelings of helplessness, sadness, irritability, anxiousness, anger or a combination of both. The impact of the condition can be vast and vary greatly. A large amount of research has been conducted into the systemic effects of MDD, however, less focus and clarity surrounds the involvement of the oral cavity. Currently, debate is still ongoing with regard to the relationship between depression and certain oral conditions. As has been well documented by Friedlander and Norman (2002), the dental issues and treatment needs of patients change as they age. MDD is predominantly reported to affect those around the ages of 18-45. If depression occurs in later years, usually over 65, it is classified as Later Life Depression (LLD). As population demographics evolve and life expectancy increases, this form of the condition becomes a significant public health concern. Already, it is the most prevalent psychiatric disease amongst those over 65. For the purposes of this paper, MDD and LLD shall be examined separately. Although symptomatically the conditions bare close resemblance, distinct oral differences need to be explored. For example, LLD raises the likelihood of issues such as root caries, denture dissatisfaction, gingival recession and limited manual dexterity. Currently, there is a dearth of information in relation to this topic accessible to dental care professionals. This review of current literature will aim to discuss in detail, the different issues arising from MDD and LLD in relation to dentistry. This will include an explanation of subjects such as periodontitis, caries, parafunctional habits, orofacial pain, dysgeusia and globus sensation, and xerostomia. Changes in behaviour will also be examined and the impact of antidepressant medication discussed.