From the Guidelines
Oral reactions with SSRIs are primarily caused by their effects on salivary flow and oral tissues, leading to dry mouth, taste disturbances, and other oral complications, as reported in a 2020 study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1. These reactions can lead to increased risk of dental caries, oral infections, and difficulty swallowing. Some patients may experience taste disturbances (dysgeusia), often described as a metallic taste. SSRIs can also cause bruxism (teeth grinding), which may lead to tooth wear, jaw pain, and temporomandibular joint disorders. Key points to consider include:
- Dry mouth (xerostomia) is a common side effect of SSRIs, caused by inhibition of acetylcholine release, which reduces saliva production 1.
- Taste disturbances (dysgeusia) and bruxism (teeth grinding) are also possible oral reactions to SSRIs 1.
- Patients experiencing these side effects should maintain excellent oral hygiene, stay hydrated, use sugar-free gum to stimulate saliva, and consult their healthcare provider if symptoms are severe, as dosage adjustments or medication changes may be necessary.
- A study published in 2020 in the Journal of the American Academy of Child and Adolescent Psychiatry found that SSRIs are generally well tolerated by children and adolescents, but can cause adverse effects such as dry mouth, nausea, diarrhea, and headache 1.
- It is essential to monitor patients closely for these oral reactions and adjust treatment as needed to minimize the risk of morbidity and mortality, and to improve quality of life 1.
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences
Oral reactions, such as dry mouth, occur with SSRIs, including sertraline, as a consequence of pharmacologic treatment.
- The exact mechanism is not explicitly stated in the label, but it is likely related to the autonomic nervous system disorders caused by SSRIs.
- Dry mouth is reported by 1% to 16% of patients taking sertraline in placebo-controlled trials 2.
- Other oral reactions may include mouth dry and dyspepsia, which are also reported as adverse events in the label 2.
From the Research
Oral Reactions with SSRIs
Oral reactions, such as dry mouth, taste disturbances, and stomatitis, can occur with the use of Selective Serotonin Reuptake Inhibitors (SSRIs) 3, 4.
- The exact mechanism of these oral reactions is not fully understood, but it is thought to be related to the increase in serotonin levels in the body, which can affect various physiological processes, including those in the oral cavity 5.
- SSRIs can cause a range of side effects, including gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 4.
- Some SSRIs, such as fluoxetine, have been associated with a higher incidence of oral reactions, such as dry mouth and stomatitis, compared to other SSRIs 3.
- The risk of oral reactions with SSRIs can be influenced by various factors, including the specific SSRI used, the dose and duration of treatment, and individual patient characteristics, such as age and medical history 6, 3.
Comparison of SSRIs
Different SSRIs can have varying rates of oral reactions, and some may be more likely to cause these reactions than others 3.
- For example, fluoxetine has been associated with a higher incidence of oral reactions, such as dry mouth and stomatitis, compared to other SSRIs 3.
- In contrast, sertraline and citalopram may have a lower risk of oral reactions compared to other SSRIs 3.
- The choice of SSRI should be based on individual patient characteristics, medical history, and the specific condition being treated, as well as the potential risk of oral reactions and other side effects 6, 3.