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

Paroxetine

Antidepressant (SSRI)

Brand names: Paxil

Oral health effects

  • Xerostomia (dry mouth)

    Paroxetine has the most anticholinergic activity of the SSRIs, so dry mouth can be more pronounced.

    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 reported in about 2% of patients vs 0% on placebo 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.

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. Association between psychotropic medications and presence of sleep bruxism: A systematic review. Melo G, Dutra KL, Rodrigues Filho R, et al. Journal of oral rehabilitation, 2018.
  3. Paroxetine prescribing information (FDA label) Preferred Pharmaceuticals, Inc / DailyMed, 2026.
  4. Risk of gastrointestinal bleeding by specific SSRIs and SNRIs: A systematic review and meta-analysis. Gomez-Lumbreras A, Tawfik AG, Del Fiol G, et al. British journal of clinical pharmacology, 2026.
  5. Systematic Review on Antidepressant Use and Bleeding Risk After Dental Extractions: Evidence Gaps and Clinical Implications. Nemeth A, Rahimi K, Karande S, et al. Journal of clinical medicine, 2025.
  6. Oral Manifestations in Patients in Treatment with Antidepressants: A Systematic Review. Alcázar-Hernández JM, Pecci-Lloret MR, Guerrero-Gironés J. Journal of clinical medicine, 2024.
  7. 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.