Metal Illness and Oral Health

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Dr Nik Sisodia urges: “Let’s talk about mental health

Most people are willing to share the most minute details of their personal lives, yet mental illnesses remain largely under wraps. According to the World Health Organisation, one in four people are affected by a mental or neurological disorder at some point in their lifetime. Approximately 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

Treatments are available to help patients manage their conditions, but nearly two-thirds of people with a known mental illness never seek professional care [1]. This is an alarming trend, considering there is evidence to suggest that those with a mental illness also suffer from poor oral health, resulting in reduced quality of life.

Mental illness affects thousands of people in the UK, regardless of their age, gender, or socio-economic background. Some of the most common mental health problems include stress, anxiety, depression, substance abuse, eating disorders, obsessive-compulsive disorder (OCD), bipolar disorder, schizophrenia, and psychosis [2]. Many of these issues are not openly discussed, nor are they obviously observed in the patients that we treat every day, so it’s easy for a mental illness to be overlooked and undiagnosed.

This can have a detrimental impact on an individual’s oral health if mental illness prevents them from being able to take sufficient care of their teeth and gums. In order for practitioners to ensure every patient benefits from essential dental treatment, it is important to first understand why so many people choose not to talk about mental illness.

There are, of course, many reasons for this, with one of these being that unlike other health conditions, mental illness is frequently seen as a sign of weakness in an individual. We would never tell someone with cancer to just “get over it”, but this is the advice that many people suffering from mental illness hear all too often.

This lack of empathy can further exacerbate an individual’s feelings of low self-worth and weakness, which is perhaps one of the many reasons why 40% of men say it would take thoughts of suicide or self-harm to compel them to seek professional help [3].

Living with a mental illness can be lonely and extremely isolating for both the people who suffer from it and for those closest to them. Patients who do pluck up the courage to speak to someone about their condition risk being doubted and criticised for “faking it” or “just looking for attention”.

Those with a mental illness often face discrimination or abuse – not just in the home and workplace, but within the wider community. According to campaign group, Time to Change, 38% of people with mental health problems say they have been treated negatively as a result of their condition [4]. The Mental Health Foundation believes that among those with a long-term health condition or disability, people with mental illness are least likely to find employment, maintain a steady relationship, live in suitable housing, or be included as part of mainstream society.

This is often a result of negative connotations associated with mental illness. For instance, many people with mental health problems are stereotyped as violent and dangerous individuals, when they are – in fact – more at risk of being attacked or harming themselves [5]. The tragic irony is that this continued stigma and discrimination can fuel feelings of shame, trapping people into a never-ending cycle of mental illness that prevents them from seeking the professional treatment they require.

Many people still do not understand the harmful effects mental illness can have on oral health. For instance, a meta-analysis of 25 studies found that people with severe mental illnesses were 2.7 times more likely to have lost all their teeth, compared to the general population [6]. People suffering from depression, dementia and schizophrenia are at an increased risk of developing oral diseases such as dental caries and periodontitis.

This is often a result of neglecting to brush or floss properly, but also due to side effects from taking psychotropic medication – including antipsychotics, antidepressants and mood stabilisers [7]. Some patients with bipolar disorder or OCD may face additional problems from overzealous or aggressive oral hygiene, which can cause dental abrasion, as well as mucosal and gingival lacerations [8].

Patients with mental illness who are also suffering from a combination of oral health problems may require specialist or multi-disciplinary dental treatment, which could be beyond your professional remit. If such is the case we’re ready to help.

Ten Dental + Facial’s team of specialist clinicians – including periodontists and endodontists – are experienced in treating complex cases, and are well equipped with the necessary skills and knowledge to manage patients with acute mental health problems. The team will ensure your patients benefit from the highest quality care, which will enable them to maintain optimal health of their teeth and gums.

As dentists, it is important that we continue encouraging open and honest discussions of mental illness within our practices, in order to eliminate the social stigma associated with such conditions. This can be particularly beneficial in helping some of the most vulnerable people within our society seek the help they need to recover.

Author

Co-founder of Ten Dental, implant surgeon Dr Nikhil Sisodia is a mentor for the Association of Dental Implantology, a study club director for the International Team in Implantology and teaches on the Implant Restoration Course. He is also a key opinion leader for Dentsply Implants, assisting in testing the viability and efficacy of new products. For more information visit www.tendental.com

References:

1] World Health Organisation. (2001) Mental disorders affect one in four people. Link: https://www.who.int/whr/2001/media_centre/press_release/en/. [Last accessed: 08.01.19].

2] Oral Health Foundation. (Unknown) Mental illness and oral health. Link: https://www.dentalhealth.org/mental-illness-and-oral-health. [Last accessed: 08.01.19].

3] Priory. (2018) 40% of men won’t talk to anyone about their mental health. Link: https://www.priorygroup.com/blog/40-of-men-wont-talk-to-anyone-about-their-mental-health. [Last accessed: 08.01.19].

4] Time to Change. (2017) New figures released on Time to Talk Day reveal the “devastating” human cost of mental health stigma. Link click HERE. [Last accessed: 08.01.19].

5] Mental Health Foundation. (2019) Stigma and discrimination. Link: https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination. [Last accessed: 08.01.19].

6] Kisely, S., Baghaie, H., Lalloo, R., Siskind, D. and Johnson, N. W. (2015) A Systematic Review and Meta-Analysis of the Association Between Poor Oral Health and Severe Mental Illness. Psychosomatic Medicine. 77(1): 83-92. doi: 10.1097/PSY.0000000000000135.

7] Lalloo, R., Kisely, S., Amarasinghe, H., Perera, R. and Johnson, N. (2013) Oral health of patients on psychotropic medications: a study of outpatients in Queensland. Australasian Psychiatry. 21(4): 338-342. doi: 10.1177/1039856213486308.

8] Clark, D. B. (2003) Dental care for the patient with bipolar disorder. Journal of the Canadian Dental Association. 69(1): 20-24. Link: http://www.cda-adc.ca/jcda/vol-69/issue-1/20.pdf. [Last accessed: 08.01.19].