Table 3.43.

Key considerations for dental management in depression (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Recognition of depression
Appropriate dental care	2	Sympathetic handling; avoid elective dental care until disease is controlled
Pain and anxiety control
– Local anaesthesia	1	Reduce epinephrine dose
– Conscious sedation	2	Avoid benzodiazepines and opioids
– General anaesthesia	3–5	Respiratory depression
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	1	Postural hypotension
Treatment modification
– Oral surgery	1
– Implantology	1/5	Xerostomia; neglected oral hygiene
– Conservative/Endodontics	1
– Fixed prosthetics	1	Avoid gingival retraction cord with epinephrine
– Removable prosthetics	0
– Non-surgical periodontology	1
– Surgical periodontology	1
Hazardous and contraindicated drugs	1	Avoid acetaminophen and erythromycin

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.