Is There a Crisis in Dental Care for Those With Severe Mental Illnesses?

New research has laid bare the dental crisis that faces those with severe mental illnesses. A study has found that those with conditions like Bipolar Disorder and Schizophrenia tend to struggle with their oral health due to a range of reasons. Anyone with these conditions is in need of enhanced dental healthcare – but very few have access to it. Going forward, change is needed to ensure the crisis doesn’t deepen.

Recent research suggests that those with severe mental illnesses are facing a dental crisis. This crisis involves struggling to access dental care, and finding it difficult to maintain strong oral health.

The research has found that those with severe mental health conditions like Bipolar Disorder and Schizophrenia are at an increased risk of poor oral health. Moreover, this study has also looked at some of the barriers facing them.

The findings of the study show that action is needed. Therefore, the authors of the study are hoping that their conclusions and recommendations are acknowledged, and that appropriate action is taken.

Background

The study looked at mental illness in the United Kingdom. In the UK, severe mental health conditions like Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and other psychoses affect 0.95% of the population [1].

Existing research has showed the close link between mental illness and subsequent poor oral health. One of the leading causes of this is dry mouth – a very common side effect of medicines that are used to treat mental health conditions, like antidepressants [2].

Those with severe mental health conditions typically have worse oral health than the general population. For example, research shows that this group has a three times higher chance of losing all of their teeth compared to the general population [2].

It is also known that oral health affects self-esteem and quality of life. Therefore, a vicious cycle can take place, where poor oral health worsens mental health [3].

The research model

The research was completed by a team of researchers at the University of York. They published their findings in the International Journal of Environmental Research and Public Health [4].

The researchers sought to find out if there were certain reasons behind the lack of access to dental care for those with severe mental illnesses, as well as other barriers.

The study involved 7 main participants. These participants were British citizens that had been diagnosed with either Schizophrenia, Schizoaffective Disorder or Bipolar Disorder [4]. These three conditions are typically seen as very severe [3].

The study involved one-on-one interviews between a researcher and participant. These interviews were semi-structured, meaning that while it meant participants were roughly asked the same questions, the participants were able to express their feelings fully [4].

The participants were asked to share their experience of caring for their oral health and use of dental services – and whether or not they had faced any challenges in the past when doing so [4]. Each interview took up to 2 hours.

The researchers also conducted additional interviews with 10 participants that were healthcare professionals – including dentists, mental health nurses and doctors [4]. These interviews focused on the professionals’ past experiences with working with those with severe mental illnesses. Furthermore, they were also asked about the best possible service that could be provided to this group [4].

The results

All of the interviews were then analysed, with the researchers finding many common themes that had been mentioned by multiple participants [4]. The interviews found that the main issues were:

• Impact of symptoms on everyday life: This was unsurprising, given the burden that severe mental illness causes a person in every way in their life. For example, for some people, just getting out of bed is an achievement – with cleaning their teeth understandably not on the top of their agenda.

• Lack of patient involvement and tailored approach: Researchers believe that dental professionals have not been educated enough on the need to take extra precautions and adopt a tailored approach to those with severe mental illness.

• Accessibility issues: A significant problem in the United Kingdom currently is the lack of dental clinics that are accepting NHS-based patients. Therefore, this makes accessing routine dental care very difficult.

• Integration issues: There is a severe lack of integration between mental health services and dental services. Therefore, those receiving mental health treatment are not being informed about the importance of oral health [4].

• Cost: Those with severe mental illnesses find it difficult to maintain regular employment. As a result, many cannot afford to pay dental fees, which are not free in the United Kingdom.

As for the health professionals that partook in interviews, there were also some interesting findings. For instance, they believed that effective communication skills were crucial in providing quality services for those with severe mental illnesses [4].

Moreover, they considered that on a personal level, they should be more positive, provide tailored support and inform the patient more about oral health [4]. They suggested that high caseloads and a lack of involvement of care coordinators affected the overall service.

What this study shows

The results of this study show that there are several barriers in place for those with mental illnesses in terms of accessing dental care. Considering how many people do suffer from mental health conditions, it is clear that a huge number of people are not receiving the care they need.

The research also shows that dental care providers could benefit from enhanced training to increase their knowledge of the needs of those with severe mental illnesses [5].

Dr. Masuma Mishu of the University of York’s Department of Health Sciences was the Lead author of this study [5]. Mishu commented on the findings.

Mishu spoke of “oral health inequalities” between those with severe mental illness and the general population, saying that “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” [5].

The authors also made recommendations that oral healthcare should be incorporated into treatment plans for those with severe mental health problems [5]. This could help to overcome some of the barriers.

Mishu hopes that such an approach “will promote a culture of discussing oral health care in mental health care settings and will enable people with severe mental illness to engage and learn about good oral health” [5]. Therefore, this vulnerable group would hopefully see an improvement in their oral health – and overall quality of life.

Thinking points…

1) This article mentions about the consequences of dry mouth. Dry mouth is something that many people suffer from. As a result, if you do have a problem with this, take extra care with your oral health. Remember to frequently sip water throughout the day. Most importantly, ensure you attend a dental clinic at least twice a year for a check-up. We recommend booking an appointment now!

2) Do you know anyone with a severe mental illness like Bipolar Disorder or Schizophrenia? As this article shows, they are vulnerable to poor oral health. Have a think about practical ways you could help them – such as reminding them of the importance of oral health, or offering to accompany them to an appointment. Therefore, this could help them hugely with their overall health.

What we offer at Taradale Dental

Taradale Dental is a Calgary Dental Clinic that provide their patients with advice, a comfortable experience and treatment to improve oral health where needed.

Importantly, we recommend brushing your teeth at least twice a day and flossing regularly. Moreover, eating healthily and trying to avoid sugary foods and drink is helpful.

We advise our patients to attend our Calgary-based dental clinic twice a year for a regular dental check-up. When problems are detected, we have many treatments available. For instance, these include cavity fillings and root canals.

Here at Taradale Dental, we also have some cosmetic treatments available! These include dental implants, tooth whitening and Invisalign™! Many people find that these treatments have a positive impact on your appearance, confidence and self-esteem.

In addition, all of our services at our Calgary dental clinic Taradale Dental are in line with the Alberta Dental Fee Guide.

We would love you to visit our Taradale Dental clinic in Calgary! You can find out more about us by visiting our website https://taradaledental.ca.

References

[1] Hayes, J. F., Marston, L., Walters, K., King, M. B., & Osborn, D. P. J. (2018). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry. 211 (3): p175-181. DOI: https://doi.org/10.1192/bjp.bp.117.202606.

[2] Kisely, S., Baghaie, H., Lalloo, R., Siskind, D., & 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): p83-82. DOI: https://doi.org/10.1097/PSY.0000000000000135.

[3] Mental Health General. (2022). New Research Shows The Oral Health Problems Facing Those With Mental Health Conditions. Available: https://www.mentalhealthgeneral.com/new-research-shows-the-oral-health-problems-facing-those-with-mental-health-conditions/. Last accessed: 28th May 2022.

[4] Mishu, M. P., Faisal, M. R., Macnamara, A., Sabbah, W., Peckham, E., Newbronner, L., Gilbody, S., & Gega, L. (2022). A Qualitative Study Exploring the Barriers and Facilitators for Maintaining Oral Health and Using Dental Service in People with Severe Mental Illness: Perspectives from Service Users and Service Providers. International Journal of Environmental Research and Public Health. 19 (7): p4334. DOI: https://doi.org/10.3390/ijerph19074344.

[5] University of York. (2022). Researchers highlight crisis in dental care for people with severe mental illness. Available: https://medicalxpress.com/news/2022-05-highlight-crisis-dental-people-severe.html