Mental-health medications
Dental Considerations for Patients Taking SSRI antidepressant (fluoxetine/sertraline)
Caution — drug considerations (SSRI)
Record of SSRI. The points below cover relevant oral side-effects and drug interactions so prescribing and treatment remain safe and non-conflicting.
Emergency vs routine management
If EMERGENCY — what to do
- • Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Avoid NSAIDs (bleeding) and tramadol (serotonin syndrome); paracetamol preferred.Ref: Stockley's Drug Interactions (current edition)
If ROUTINE — what to do
- • Routine care; manage xerostomia.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Clinical precautions
- • May increase bleeding tendency (platelet effect) — use local haemostatic measures for surgery.
- • Caution with NSAIDs (added bleeding risk); xerostomia common.
- • Adrenaline in LA is acceptable in usual doses.
- • Avoid prescribing drugs that interact; verify any new prescription against the patient's full medication list.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Supragingival scaling / polish | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Root canal treatment | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Surgical / bony extraction | MODIFY / CAUTION Caution — drug considerations (SSRI) |
| Implant placement | MODIFY / CAUTION Caution — drug considerations (SSRI) |
References
- Drug considerations in dentistry (oral side-effects & interactions)
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- Stockley's Drug Interactions (current edition)
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.