Olanzapine-related oral health impairments: a scoping review and construction of a management framework

BACKGROUND: Olanzapine is a commonly used second-generation antipsychotic. However, evidence on its oral health effects remains scattered, and clinical awareness is limited. OBJECTIVE: This review systematically identifies the spectrum and epidemiological characteristics of olanzapine-related oral health impairments. It also proposes a framework for their pathogenesis, outlines existing management strategies, and clarifies evidence gaps. METHODS: We followed the JBI scoping review methodology and PRISMA-ScR guidelines. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to December 31, 2025. Original studies and reviews focusing on olanzapine and oral health outcomes were included. Data were extracted using standardized tables and synthesized through thematic induction, evidence mapping, and gap analysis. RESULTS: A total of 18 studies meeting the inclusion criteria were finally included. A spectrum of oral impairments was identified. Reported prevalences included xerostomia (30%-60%), moderate-to-severe periodontitis (35.9%-60%), and oral ulcerations (16.19 per 1000 person-years). The DMFT (Decayed, Missing, Filled Teeth) index for dental caries ranged from 13.5 to 28.6. Oral bacterial-fungal dual dysbiosis was prevalent, and the risk of tongue movement abnormalities was increased (reporting odds ratio [ROR] = 6.7). This study proposed a "quadruple pathway synergistic amplification" model, which encompasses anticholinergic effects, metabolic disorders, microbial dysbiosis, and central neuro-behavioral abnormalities. The model suggests a potential interplay among drug effects, microbiota, metabolism, and inflammation. Current management is dominated by oral health education, with a lack of multidisciplinary collaboration; 70.6% of study outcome measures were non-standardized, with obvious evidence gaps. CONCLUSION: Olanzapine-related oral health impairments appear common and potentially substantial, which may have potential clinical relevance. The stepwise "assessment-prevention-intervention-collaboration" management framework proposed in this study may provide a preliminary theoretical basis for future clinical hypothesis testing. These findings are hypothesis-generating and require validation in prospective cohorts and trials.