Friedlander Arthur H, Norman Dean C
Veterans Affairs Greater Los Angeles Healthcare System, CA 90073, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Oct;94(4):404-12. doi: 10.1067/moe.2002.122434.
Late-life depression (LLD) initially occurs after age 65 years and is a major public health concern because the elderly who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioral patterns are impaired, causing the individual distress, compromising social function, and impairing self-maintenance skills (eg, bathing, dressing, hygiene). LLD characterized by marked sadness or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty in concentration, and a high suicide rate. Diagnosis of LLD is sometimes complicated by a denial of mood change and an inability to distinguish symptoms of a concurrent physical illness from those of a depressive etiology. The disorder is most frequently treated with antidepressant medications, and although older individuals have a recovery rate that is comparable with younger adults, they often take longer to recover, have more frequent relapses, and are more sensitive to the side effects of the drugs.
Individuals undergoing treatment for LLD and those whose illness has not been diagnosed or treated often are seen with significant oral disease by the dentist. Dentists need to be cognizant of how to safely and compassionately provide care to those already receiving mental health services. They must also be familiar with the psychiatric symptoms of the disorder to effectuate a timely referral to a physician of those with occult or relapsing disease. LLD is frequently associated with a disinterest in oral hygiene, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education program, the use of artificial salivary products, antiseptic mouthwash, daily fluoride mouth rinse, and special precautions in administration of local anesthetics with vasoconstrictors and prescription of analgesics.
Dentists who invoke appropriate precautions can usually provide a full range of services to individuals with LLD, thereby enhancing patient self-esteem and contributing to the psychotherapeutic aspect of management.
老年期抑郁症（LLD）最初发生在65岁之后，是一个重大的公共卫生问题，因为处于高风险的老年人在人口中所占比例不断扩大。老年期抑郁症是一种精神疾病，其情绪、思维内容和行为模式受损，导致个体痛苦，损害社会功能，并损害自我维持技能（如洗澡、穿衣、卫生）。老年期抑郁症的特征是明显的悲伤或对日常活动失去兴趣或愉悦感，可能伴有体重变化、睡眠障碍、疲劳、注意力不集中和高自杀率。老年期抑郁症的诊断有时会因否认情绪变化以及无法区分并发身体疾病的症状与抑郁病因的症状而变得复杂。该疾病最常使用抗抑郁药物治疗，尽管老年人的康复率与年轻人相当，但他们通常恢复时间更长，复发更频繁，并且对药物副作用更敏感。
接受老年期抑郁症治疗的个体以及那些疾病未被诊断或治疗的个体，牙医经常会发现他们患有严重的口腔疾病。牙医需要知道如何安全且富有同情心地为那些已经接受心理健康服务的人提供护理。他们还必须熟悉该疾病的精神症状，以便及时将患有隐匿性或复发性疾病的患者转诊给医生。老年期抑郁症通常与对口腔卫生不感兴趣、致龋饮食、唾液分泌减少、猖獗性龋齿、晚期牙周疾病和口腔感觉异常有关。许多用于治疗该疾病的药物会加重口干，并增加牙科疾病的发生率。适当的牙科管理需要积极的预防性牙科教育计划、使用人工唾液产品、抗菌漱口水、每日含氟漱口水，以及在使用含血管收缩剂的局部麻醉剂和开具镇痛药时采取特殊预防措施。
采取适当预防措施的牙医通常可以为老年期抑郁症患者提供全方位的服务，从而提高患者的自尊，并有助于管理的心理治疗方面。
