Oral Complications in Patients With Psychiatric Illness Undergoing Electroconvulsive Therapy in Istanbul, Turkey.

OBJECTIVE: Despite advances in pharmacotherapy, electroconvulsive therapy (ECT) remains a mainstay treatment option in psychiatry. This study aims to determine the occurrence of oral injury from ECT modified with the use of an inexpensive, disposable, hand-made oral protector customized to the dental needs of the individual patient. METHOD: Based on data collected between January 1, 2013, and December 31, 2018, registered patients who had received ECT were evaluated retrospectively. We investigated the incidence of oral complications such as dental fractures, dental avulsion, temporomandibular joint dislocation, jaw pain, and soft tissue, lip, and tongue injuries in a single center. RESULTS: There were 1750 male patients (59.6%) and 1187 female patients (40.4%), with a mean age of 35.20 ± 11.59 years. The incidence of oral injury was 0.1% per patient (4/2937) and 0.01% per session (4/22135). Oral complication characteristics included mucosal abrasion in 2 patients, dental fracture in 1 patient, and tooth avulsion in one. No dental fracture or avulsion in our patient population has resulted in aspiration. We found no evidence of jaw pain, temporomandibular joint dislocation, or injury to the lip or tongue. CONCLUSION: Our results demonstrate a minimum risk of oral complications during ECT and also provide additional justification for an adequate oral assessment by the ECT team before the procedure.

Does the Use of Rocuronium-Sugammadex Instead of Succinylcholine in Electroconvulsive Therapy Affect Seizure Duration?

OBJECTIVE: We compared retrospectively the seizure variables of electroconvulsive therapy (ECT) patients after administration of rocuronium-sugammadex or succinylcholine as a muscle relaxant with propofol anesthesia. METHODS: The sample comprised 134 ECT patients. The mean age was 33.6±10.48 years. Anesthesia induction was provided with propofol one mg kg-intravenously (IV) followed by succinylcholine 0.5 mg kg-1 IV (n=68) (Group S) or rocuronium 0.3 mg kg-1 IV (n=66) (Group R). For patients who were given rocuronium, reversal of the residual neuromuscular block was accomplished with sugammadex (1.5 mg kg-1 IV). First session seizure variables were compared between the two groups. We also presented the clinical outcome with Clinical Global Impression-Improvement (CGI-I) and overall adverse effects. RESULTS: EEG seizure durations in Group R (55.09±36.11 s) and Group S (47.00±26.33 s) were comparable and were not significantly different (p=0.432). The clinical efficacy of ECT measured by CGI-I in both groups was comparable (p=0.075). There were no major complications or death during or after ECT. CONCLUSION: The results of this study show that the use of rocuronium-sugammadex as a neuromuscular blocker instead of succinylcholine during ECT with propofol anesthesia produces similar results in terms of seizure variables and clinical outcomes.

Oral Health among Patients with Bipolar Disorder.

PURPOSE: To compare the oral health of patients with bipolar disorder (BD) with a control group of subjects. MATERIALS AND METHODS: The study sample comprised 242 patients with BD and a mean age of 35.8 years. The control group comprised 187 subjects and a mean age of 37.3 years. Oral health was assessed through clinical examination by the Decayed, Missing, and Filled Teeth (DMFT) Index, the Community Periodontal Index (CPI), and the Simplified Oral Hygiene Index (OHI-S). RESULTS: Patients with BD had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than control group subjects. The average DMFT index score was 10.0 (SD = 5.7) in the BD group and 8.1 (SD = 5.2) in the control group (p = 0.002). The mean value of decayed teeth in patients with BD (4.5) was significantly higher than that of the control group (2.3) (p < 0.001). Periodontal diseases were significantly more prevalent among patients with BD (p < 0.001), particularly regarding shallow and deep pockets (47.1% vs. 16.6%). Oral dryness (xerostomia) and severe tooth wear were also more prevalent among patients with BD (p < 0.001). Statistically significant risk factors for higher DMFT scores were: older age and having BD; CPI scores of 3 or 4; having BD, male gender, older age, and lower educational level. CONCLUSION: Poorer oral health among patients with BD is represented mostly as caries and advanced periodontal disease. The results of this study highlight the necessity to intensify preventive dentistry in this vulnerable population.

Palate size and shape in schizophrenia.

The palate is considered typical of the structures in which schizophrenia-related minor physical anomalies may occur. In this study, we aimed to compare the dimensions and form of palate in patients with schizophrenia with nonpsychiatric controls in a blinded manner. Dental stone casts of 127 patients with schizophrenia and 127 controls were prepared from impressions of the maxillary dental arch. Palate dimensions were measured on the stone casts using a digital caliper and palatometer. Palate length did not differ significantly between the groups, but there was a significant difference in palate width and depth, which were significantly higher in the schizophrenia group. As a result of using multivariate analysis for assessing independent risk factors affecting patients with schizophrenia, furrowed palate shape, palate width, and ellipsoid maxillary dental arch shape were found to be significant. This study also revealed that patients with schizophrenia demonstrate certain gender-related predilections in the differences of palate parameters compared to same-sex controls. As the palate develops in conjunction with both the face and brain, our study findings can significantly contribute to the assumption that there might be structural abnormalities of the palate that could represent specific markers of embryological dysmorphogenesis underlying schizophrenia.