PSYCHOTROPIC-INDUCED XEROSTOMIA AND ITS IMPACT ON ORAL HEALTH IN SCHIZOPHRENIA

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Simona Bida, Teona Tudorici, Daniela Argatu, Andrei Georgescu, Razvan-Constantin Branzan, Gabriel Rotundu, Magda Calina Barlean

ABSTRACT

Schizophrenia is a chronic psychiatric disorder requiring long-term pharmacological management with antipsychotics, antidepressants, and mood stabilizers. While these medications are essential for symptom control and relapse prevention, their pharmacodynamic properties often induce xerostomia, a condition characterized by reduced salivary flow and altered oral homeostasis. Psychotropic-induced xerostomia is increasingly recognized as a multifactorial phenomenon that extends beyond a mere adverse effect, representing a convergence of pharmacological inhibition, neurobiological dysregulation, behavioural neglect, and social vulnerability. Through antagonism of muscarinic M1 and M3 receptors, dopaminergic modulation, and autonomic imbalance, drugs such as clozapine, olanzapine, and tricyclic antidepressants diminish salivary secretion and buffering capacity, predisposing to microbial dysbiosis and mucosal inflammation. Metagenomic studies have revealed that xerostomia environments favour acidogenic and proteolytic bacteria, including Streptococcus mutans, Lactobacillus spp., and Porphyromonas gingivalis, alongside opportunistic fungal colonization by Candida albicans. These microbiological and biochemical shifts lead to caries, periodontal breakdown, and chronic oral infection, while sustained inflammatory signalling may contribute to systemic and neuroinflammatory processes relevant to schizophrenia pathophysiology. Behavioural and psychosocial factors—such as cognitive impairment, avolition, smoking, poor diet, social isolation, and stigma—exacerbate oral disease progression by limiting hygiene and access to care. Collectively, these mechanisms illustrate the bidirectional relationship between oral and mental health. Interdisciplinary approaches integrating dental and psychiatric care, preventive interventions, salivary management, and patient education are crucial for improving quality of life and systemic outcomes in this population. Future research should focus on longitudinal biomarker-based studies and the development of integrated care models addressing both neuropsychiatric and oral health dimensions.