Bipolar I disorder: psychopathology, medical management and dental implications.
BACKGROUND
The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental management of patients who have bipolar I disorder, or BD, previously known as manic-depressive disorder.


METHODS
The authors conducted a MEDLINE search for the period 1995 through 2001 using the key terms "bipolar disorder," "epidemiology," "pathophysiology," "treatment" and "dentistry." The articles they selected for further review included those published in English in peer-reviewed journals; they gave preference to articles reporting randomized, controlled trials.


RESULTS
BD is a psychiatric illness characterized by extreme mood swings. Mania is accompanied by euphoria, grandiosity, racing thoughts and lack of insight. Depression is characterized by marked sadness or loss of interest or pleasure in daily activities. The unpredictable mood swings can distress the person, can impair social function and quality of life and are associated with a significant increase in the risk for substance abuse and suicide. BD is common in the United States, with a lifetime prevalence rate of 1.6 percent and recurrence rate of more than 50 percent.


CONCLUSIONS
The prevalence of dental disease usually is extensive because of poor oral hygiene and medication-induced xerostomia. Preventive dental education, saliva substitutes and anticaries agents are indicated. To avoid adverse drug interactions with the usually prescribed psychiatric medications, special precautions should be taken when administering certain antibiotics, analgesics and sedatives.
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D017742:Dental Care for Chronically Ill; D003731:Dental Caries / Q000209:etiology; D004347:Drug Interactions; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D010510:Periodontal Diseases / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014987:Xerostomia / Q000209:etiology
D000928:Antidepressive Agents; D018692:Antimanic Agents; D016651:Lithium Carbonate