Panic disorder: psychopathology, medical management and dental implications.
BACKGROUND
This article reviews the clinical features, epidemiology, pathophysiology, dental findings, and dental and medical management of the care of patients with panic disorder, or PD.


METHODS
The authors conducted a MEDLINE search for the period 1998 through 2003, using the key term "panic disorder" to define the pathophysiology of the disorder, its epidemiology and dental implications. The articles they selected for further review included those published in peer-reviewed journals.


RESULTS
PD is a common and debilitating psychiatric disease in which a person experiences sudden and unpredictable panic attacks, or PAs, with symptoms of overwhelming anxiety, chest pain, palpitations and shortness of breath. Persistent concern about having another attack and worry that it may indicate a heart attack or "going crazy" impairs the person's social, family and working lives. Frequently accompanying the disorder is agoraphobia, depression and mitral valve prolapse, or MVP.


CONCLUSIONS
In patients with PD, the prevalence of dental disease may be extensive because of the xerostomic effects of psychiatric medications used to treat it. Dental treatment consists of preventive dental education and prescribing saliva substitutes and anticaries agents. Precautions must be taken when prescribing or administering analgesics, antibiotics or sedative agents that may have an adverse interaction with the psychiatric medications. Because there is a connection between PAs and MVP, the dentist needs to consult with the patient's physician to determine the presence of MVP and whether there is associated mitral valve regurgitation. Patients with MVP and accompanying mitral valve regurgitation require prophylactic antibiotics when undergoing dental procedures known to cause a bacteremia and heightened risk of endocarditis.
VA Greater Los Angeles Healthcare System, Calif 90073, USA. arthur.friedlander@med.va.gov
Arthur H
AH
Friedlander
Stephen R
SR
Marder
Eric C
EC
Sung
John S
JS
Child
D014151:Anti-Anxiety Agents / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001521:Behavior Therapy; D001569:Benzodiazepines / Q000009:adverse effects; D017742:Dental Care for Chronically Ill / Q000379:methods*; D004347:Drug Interactions; D006801:Humans; D008945:Mitral Valve Prolapse / Q000209:etiology; D016584:Panic Disorder / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D014987:Xerostomia / Q000139:chemically induced
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D017367:Selective Serotonin Reuptake Inhibitors