Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Medication

Paliperidone

Antipsychotic (atypical)

Brand names: Invega

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.

  • Tardive dyskinesia (lower risk)

    Active metabolite of risperidone; orofacial dyskinesia possible with long-term use.

    Clinical management: Monitor for involuntary orofacial movements; refer.

  • Dizziness on standing (orthostatic hypotension)

    Orthostatic hypotension and syncope are a label warning (alpha-adrenergic blockade).

    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.

Sources

  1. A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Wolff A, Joshi RK, Ekström J, et al. Drugs in R&D, 2017.
  2. A review and guide to drug-associated oral adverse effects-Dental, salivary and neurosensory reactions. Part 1. Teoh L, Moses G, McCullough MJ. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 2019.
  3. Adverse drug events in the oral cavity. Yuan A, Woo SB. Oral surgery, oral medicine, oral pathology and oral radiology, 2015.
  4. Paliperidone prescribing information (FDA label) Westminster Pharmaceuticals, LLC / DailyMed, 2026.