Watanabe Motoko, Tu Trang Thi Huyen, Takao Chihiro, Maeda Chizuko, Nayanar Gayatri Krishnakumar, Tominaga Risa, Kimura Yasuyuki, Takenoshita Miho, Yoshikawa Tatsuya, Sumi Koji, Sumi Satoko, Motomura Haruhiko, Nagamine Takahiko, Toyofuku Akira
Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Front Psychiatry. 2023 Mar 28;14:1137917. doi: 10.3389/fpsyt.2023.1137917. eCollection 2023.
Drug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to investigate clinical characteristics including detailed complaints in patients with drug-induced open bite.
Of the outpatients who first visited the psychosomatic dental clinic at the Tokyo Medical and Dental University Hospital between September 2013 and September 2022, the patients diagnosed with drug-induced open bite were involved in this study. The clinical characteristics including sex, age, detailed complaints, duration of illness, abnormal findings, psychotropic medications, and other medications that were taken at the first examination, psychiatric comorbidities, the duration of psychiatric diseases, and other medical histories were collected retrospectively by reviewing their medical chart.
Drug-induced open bite was found in 11 patients [women: 7, men: 4, median of age: 49 (36.5, 53) years old]. Difficulty in eating especially chewing was the major complaint (9/11, 81.6%) with the duration of illness as 48.0 (16.5, 66) months. Various degrees of open bite were observed. While some showed no occlusal contact on frontal teeth, some showed occlusal contact only on the second molars; moreover, the jaw showed a horizontal slide in a few patients. Three cases could be followed up for prognosis; while in one case the drug-induced open bite improved with 6 months of follow-up, two cases did not improve, and one showed extrusion of molars. All of them had psychiatric comorbidities with the most common diagnosis being schizophrenia ( = 5) and depression ( = 5) followed by insomnia ( = 1) and autism spectrum disorder ( = 1) including duplicated diagnosis. Nine patients (81.6%) had been undergoing treatment with antipsychotics of which three patients were also taking antidepressants.
Although a drug-induced open bite is a rare symptom, prudent medical interviews about symptoms, psychiatric comorbidities, and psychotropic medication history besides oral assessment are necessary to provide a precise diagnosis and appropriate management in collaboration between dentists and psychiatrists.
药物性开颌是锥体外系症状之一，伴有肌肉张力异常，在牙科领域很少被认识到。这是一项回顾性病例研究，旨在调查药物性开颌患者的临床特征，包括详细的主诉。
在2013年9月至2022年9月期间首次就诊于东京医科齿科大学医院身心牙科诊所的门诊患者中，纳入被诊断为药物性开颌的患者。通过查阅病历，回顾性收集临床特征，包括性别、年龄、详细主诉、病程、异常表现、精神科用药以及首次检查时服用的其他药物、精神科合并症、精神疾病病程和其他病史。
在11名患者中发现了药物性开颌[女性：7名，男性：4名，年龄中位数：49（36.5，53）岁]。进食困难尤其是咀嚼困难是主要主诉（9/11，81.6%），病程为48.0（16.5，66）个月。观察到不同程度的开颌。一些患者前牙无咬合接触，一些患者仅第二磨牙有咬合接触；此外，少数患者下颌出现水平滑动。3例患者进行了预后随访；1例患者在6个月的随访中药物性开颌有所改善，2例未改善，1例出现磨牙伸长。所有患者均有精神科合并症，最常见的诊断是精神分裂症（=5）和抑郁症（=5），其次是失眠（=1）和自闭症谱系障碍（=1），包括重复诊断。9名患者（81.6%）一直在接受抗精神病药物治疗，其中3名患者还服用抗抑郁药。
尽管药物性开颌是一种罕见症状，但除了口腔评估外，谨慎地询问有关症状、精神科合并症和精神科用药史的医学问题对于牙医和精神科医生合作提供准确诊断和适当治疗是必要的。
