Diagnosis of Tardive Dyskinesia in an Oral Surgical Office

Abstract

Tardive dyskinesia (TD) presents as uncontrolled, repetitive movements of the body, typically beginning with orofacial structures, due to antipsychotic medications. The two classes of antipsychotics, atypical and typical, are mainly distinguished by their likelihood of producing extrapyramidal side effects (EPS), with atypical producing lower rates. Our case discusses a patient who presented at our clinic for dental extractions. Pre-operative consultation presented the rapid, repetitive tongue, lip, and cheek movements characteristic of tardive dyskinesia. An extensive search through her medical history showed long-term antipsychotic usage. After a consultation revealed she had never seen a psychiatrist outside of acute care centers, we referred her to a psychiatrist to evaluate her medications as she had been taking a typical antipsychotic. During the follow-up appointment, our patient's tardive diagnosis was confirmed by a psychiatrist and she had been prescribed an atypical antipsychotic. The clinical implications of this report are to encourage dental professionals to understand the medications associated with mental illnesses, as they can significantly affect oral health and other motor functions. Although we were unable to prevent the onset of tardive dyskinesia in our patient, her case serves as a cautionary reminder of the consequences when mental illnesses go unchecked and how dental professionals can potentially prevent a life-changing condition in their patients.