Duloxetine

Oral health effects

• Xerostomia (dry mouth)

  Reduced salivary flow raising caries, candidiasis, and mucosal discomfort risk.

  Clinical management: Hydration, sugar-free gum/xylitol, salivary substitutes, high-fluoride products; reinforce caries prevention.

• Bruxism

  A 2018 systematic review found increased odds of sleep bruxism with this drug (low-certainty evidence).

  Clinical management: Assess for wear; consider an occlusal guard; discuss with prescriber if severe.

• Increased bleeding tendency (impaired platelet function)

  Drugs that block serotonin reuptake reduce platelet serotonin and can increase bleeding (FDA label warning), especially when combined with aspirin, NSAIDs or anticoagulants. Dental studies suggest clinically significant oral bleeding is uncommon.

  Clinical management: No need to stop the antidepressant before scaling or root planing. Expect possible extra gingival bleeding; use local measures (pressure, hemostatic agents) and ask about aspirin, NSAIDs or anticoagulants, which add to the risk. Prefer acetaminophen over NSAIDs when suggesting post-procedure analgesia.

• Taste disturbance (dysgeusia)

  Altered taste is listed as a frequent adverse reaction ("dysgeusia") in the FDA label.

  Clinical management: Ask about altered or metallic taste, which can reduce appetite and oral comfort; reassure that it is drug-related and often fades. Rule out oral candidiasis or poor hygiene as contributors and encourage sugar-free options rather than sweet foods/drinks used to mask the taste.

• Dizziness on standing (orthostatic hypotension)

  Orthostatic hypotension, falls and syncope are a label warning, most often in the first week of therapy or after dose increases.

  Clinical management: Raise the chair slowly at the end of the appointment and have the patient sit upright for a minute or two before standing; steady them as they get up. Ask about dizziness on standing, especially after dose changes or in older patients.