(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
PEOPLE with severe mental illness are “falling through the cracks” when it comes to oral health care, a new study shows.
“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,” said Dr. Masuma Mishu of the Department of Health Sciences at the University of York (England) and lead author of the study.
“During a mental health crisis, physical health can be overshadowed. This includes oral health which can lead to long-term dental problems, pain and oral disease,” said Professor Lina Gega, of the University of York Department of Health Sciences and co-author of the study.
The study, published in the International Journal of Environmental Research and Public Health, explores the reasons why people with severe mental illness – such as Schizophrenia and bipolar disorder – struggle to maintain good oral health and access dental care, leaving them three times more likely than the general population to lose all their teeth.
The qualitative study involved seven participants with severe mental health conditions. A further 10 participants were healthcare professionals including dentists, care givers, mental health nurses and doctors.
Study participants identified costs as a key barrier to accessing dental care.
“It’s having access to quality dental care… shall we not pay my rent; no, I am okay with brown teeth and a bit of plaque. You know you’re asking people to make those sort of choices,” said one participant with a diagnosis of bipolar disorder.
Oral health is an important part of general health. 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 severe mental illness suffer from schizophrenia, bipolar affective disorder and other psychoses. They have some of the worst health indices and the lowest life expectancy in the United Kingdom, according to the study.
The burden of oral disease is particularly high in people with severe mental illness and it remains a largely neglected issue, the researchers say.
The evidence shows that oral health among people with severe mental illness have a nearly three times higher chance of losing all their teeth and higher rates of tooth decay.
Complications from untreated tooth decay are reported to be a common cause of non-psychiatric hospital admissions among patients with severe mental illness.
“This means that, in addition to the impacts on individual health, oral disease may have implications for health services, including the associated costs of treatment,” the researchers say.
Individuals with severe mental illness were 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 among those with severe mental illness.
People with severe mental illness are also less likely to access dental services and receive routine dental care.
In addition, 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.
***
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.
***
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./PN
