tBy Dr. Joseph D. Lim
Patients who have severe mental illness (SMI) are three times more likely to face total edentulism or complete loss of teeth than the general population.
This one of the findings of a study led by Dr. Masuma Pervin Mishu of the Department of Health Sciences, Faculty of Sciences, University of York in England. It was conducted with colleagues at Hull York Medical School, University of York and the Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London.
“People with severe mental illness have poorer oral health compared to those without mental illness and untreated tooth decay is a common cause of non-psychiatric hospital admissions for this group,” Dr. Mishu, an epidemiological researcher at the University of York, said in a press statement.
The study, which suggests changes that could be made by the National Health Service (NHS) of the United Kingdom, “addresses the urgent need to understand the reasons behind these oral health inequalities,” she said.
Dental and mental health services should be one in supporting people with severe mental illness, suggests the study published in the International Journal of Environmental Research and Public Health.
Seven participants with severe mental illnesses, such as schizophrenia, schizo-affective disorder or bipolar disorder, were interviewed, in addition to 10 healthcare professionals, including carers, dentists, nurses and doctors.
Participants with SMI said the most significant barriers to maintaining good oral health as being a general struggle to take care of their overall health owing to their illnesses.
They have limited finances, and difficulty in finding a dentist within a reasonable distance who would not drop them as a patient for missing appointments owing to their mental health.
The patients noted a need for a dental care provider they could trust, particularly one who was trauma-informed and generally educated on psychological issues.
People with severe mental illness suffer from a high burden of oral diseases, which can negatively impact their physical and mental well-being, the study observed.
And yet, despite the high burden, they are less likely to engage in oral health care including accessing dental services.
Oral diseases affect at least 3.58 billion people worldwide. Oral health affects aspects of social life, including self-esteem, social interaction, job performance, and overall quality of life.
In addition, oral diseases are associated with other physical health conditions, such as diabetes and coronary heart diseases. People with SMI have some of the worst health indicators and the lowest life expectancy in the UK.
According to the study, the burden of oral disease is particularly high in people with SMI and it remains a largely neglected issue.
The evidence shows that oral health among people with SMI is poorer than among the general population, the study pointed out. They have a nearly three times higher chance of losing all their teeth and higher tooth decay compared with people without SMI.
Poor oral health has a profound effect on their general health and quality of life. For example, complications from untreated tooth decay are reported to be a common cause of non-psychiatric hospital admissions among patients with SMI.
Despite the importance of oral health, maintenance of regular oral hygiene remains a challenge for those with SMI. They are significantly less likely to maintain regular tooth brushing in comparison with the general population.
Behavioral risk factors for oral health, such as higher levels of consumption of sugary food and drinks, are also more common amongst those with SMI.
Maintaining good oral health can be particularly difficult for this population due to specific challenges, such as side effects of anti-psychotic and anti-depressant medications (e.g., dry mouth) and co-morbidities associated with mental and physical health conditions.
Dental anxiety, phobia, symptoms of mental illness, and lack of support systems may also contribute to reluctance for dental visiting or maintenance of oral hygiene.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De La Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./WDJ