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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 27-28

Exploring the oral health status of patients with psychological issues


School of Allied Health, Anglia Ruskin University, Chelmsford, United Kingdom

Date of Submission01-Nov-2021
Date of Acceptance20-Dec-2021
Date of Web Publication9-Mar-2022

Correspondence Address:
Russell Kabir
Senior Lecturer, School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_42_21

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How to cite this article:
Syed HZ, Kabir R. Exploring the oral health status of patients with psychological issues. J Prim Care Dent Oral Health 2022;3:27-8

How to cite this URL:
Syed HZ, Kabir R. Exploring the oral health status of patients with psychological issues. J Prim Care Dent Oral Health [serial online] 2022 [cited 2022 May 27];3:27-8. Available from: http://www.jpcdoh.org/text.asp?2022/3/2/27/339310



It is a well-established fact that oral health is an essential factor in the general health and well-being of an individual. While there has been a general improvement in the oral health of the general population, vulnerable individuals (e.g., people suffering from mental health conditions) do not show a similar trend.[1],[2] Mental illness, as a term, is described as “a recognizable pattern of psychological symptoms or behaviors which causes poor health, personal distress, and distress to others.”[3] Mental illness cannot be confined to a single condition or a particular group of sick people in society. Mental illnesses can range from minor distress to severe mental disability, which affects an individual's overall health and well-being of an individual.[4] Oral health affects an individual's general health, self-esteem, and quality of life but has not been prioritized as a factor affecting mental health and thus remains under-researched.[5]

Oral and mental health are strongly correlated. While poor oral health contributes to low self-esteem and low self-confidence, triggering anxiety and depressive episodes, the medical management of mental disorders can cause xerostomia, increased risk of gingival diseases, higher risk of caries. Severe mental disorders result in neglect of oral hygiene.[6] Oral health problems are prevalent among people living with severe mental illnesses with higher tooth loss and decay which remains untreated. There are various barriers associated with timely treatment of these cases, including stigma, the extra cost associated with dental treatment, and the mental health condition and communication barriers.[7] Moreover, there are associated behavioral risk factors that further consolidate the link between oral and mental health. For example, eating disorders, alcohol and tobacco consumption, substance abuse are all precursors of diabetes, cardiovascular diseases, respiratory infections, and head-and-neck cancers, leading to poor oral and general health.[8]

Furthermore, several factors determine oral health, alleviate self-care, and affect oral health care's routine access and endowment in adults with mental health conditions. These factors include severity, type, and stage of mental illness. Other factors include the person's mood, motivation and self-awareness, perception of the importance of oral health and hygiene by the individual and side effects of medication.[9] Drug abuse is another factor linking both oral and mental health. Chronic drug use is primarily a manifestation of decreased self-image, depression, and lack of purpose or motivation in an individual. This directly influences oral health in terms of oral hygiene habits and diet. Drug abuse, at the very least, leads to periodontal problems because of a high incidence of smoking and neglect, trauma and dentofacial injury, which is often left untreated and consumption of products that can lead to precancerous lesions.[10] Oral health about the elderly population is often overlooked. There is documented evidence suggesting a higher incidence of oral health issues among older adults, especially the cognitively impaired older adults (mainly dementia). Studies show a strong relationship between dementia and oral conditions such as salivary dysfunction, caries, and other oral health conditions, which can be attributed to the cognitive decline experienced by these individuals.[11] Despite the literature, oral health among individuals with mental health conditions remains an underrated and less researched area and requires attention.

Oral health is a part of physical health, which is less documented as affecting mental health. Oral health affects an individual's quality of life, motivation and self-esteem, speech, diet, and other social and psychological aspects. Individuals with severe mental health issues are more vulnerable to the risk of developing oral health issues, making them susceptible to chronic illnesses such as coronary heart disease, diabetes, hyperlipidemia, and respiratory conditions.[12] An increased prevalence of caries, missing teeth, and periodontal diseases have been found in patients with severe mental health issues.[12],[13] About 20% of the global population suffers from a mental health disorder which shows the importance of oral health in people diagnosed with these conditions. Routine and effective oral care is crucial in maintaining both in and outpatients.[14] Psychological distress and depression are also associated with poor dental health and related lower quality of life. Several studies point out the oral health status of patients in psychiatric clinics. Still, only limited research is done to evaluate the oral health status of the general population living with poor mental health.[15] The factors that contribute to poor oral health in adults with serious mental health issues are a poor perception of oral hygiene needs, low socioeconomic conditions, limited health insurance, and dental teams' incapacity to manage psychiatric patients. The study also reports a lifetime prevalence of sub-optimal oral health among these individuals to be 61%.[9]

Similarly, the study done by Sekiguchi et al. reports psychological distress to be a substantial contributing factor to oral health quality of life (OHQoL). They indicate the need to consider the patient's psychological background as a variable in the patient's subjective symptoms, such as atypical facial or dental pain or self-assessed xerostomia. The study results show that people with poor mental conditions or psychological distress subjectively perceive lower OHQoL compared to the general population.[15]

Scoping review findings indicated that not much had been developed to improve the oral health status of people suffering from mental illnesses, despite it being an essential factor affecting all aspects of life.[14] Moreover, approximately 34% and 43% of people with mental health issues visit the dentist annually compared to 61% of the general population. This reinforces the fact that self-care practices are reduced in people with serious mental illnesses.[16] The psychotropic drugs used in the pharmacological treatment of mental disorders can cause dry mouth, as do substances such as cocaine, opiates, and amphetamines. Patients with severe mental conditions such as schizophrenia have more decayed and missing teeth and a lower number of filled teeth, suggesting a hindrance in dental treatment access, despite the dire need.[17] The findings indicate the dire need for oral health promotion interventions among individuals with mental health conditions. Not enough research has been conducted in this area, especially among the general population suffering from psychological distress and are not in psychiatric establishments. This article intends to highlight this public health concern and help improve oral health among people struggling with poor mental health.



 
  References Top

1.
World Health Organization. The World Health Report 2003: Shaping the Future. World Health Organization; 2003.  Back to cited text no. 1
    
2.
Petersen PE. Priorities for research for oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Community Dent Health 2005;22:71-4.  Back to cited text no. 2
    
3.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization; 1992.  Back to cited text no. 3
    
4.
Thompson D, Pudney M. Mental Illness: The Fundamental Facts. Mental Health Foundation; 1990.  Back to cited text no. 4
    
5.
Angelillo IF, Grasso GM, Sagliocco G, Villari P, D'Errico MM. Dental health in a group of drug addicts in Italy. Community Dent Oral Epidemiol 1991;19:36-7.  Back to cited text no. 5
    
6.
El Tantawi M, Folayan MO, Oginni O, Adeniyi AA, Mapayi B, Yassin R, et al. Association between mental health, caries experience and gingival health of adolescents in sub-urban Nigeria. BMC Oral Health 2021;21:223.  Back to cited text no. 6
    
7.
McGrath R, Marino R, Satur J. Oral health promotion practices of Australian community mental health professionals: A cross sectional web-based survey. BMC Oral Health 2021;21:85.  Back to cited text no. 7
    
8.
DHSV. Links Between Oral Health and General Health: The Action Case. Victoria: Dental Health Services Victoria; 2011.  Back to cited text no. 8
    
9.
Matevosyan NR. Oral health of adults with serious mental illnesses: A review. Community Ment Health J 2010;46:553-62.  Back to cited text no. 9
    
10.
Griffiths J, Jones V, Leeman I, Lewis D, Patel K, Wilson K, et al. Oral Health Care for People with Mental Health Problems Guidelines and Recommendations. London: British Society for Disability and Oral Health; 2000.  Back to cited text no. 10
    
11.
Wu B, Plassman BL, Crout RJ, Liang J. Cognitive function and oral health among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2008;63:495-500.  Back to cited text no. 11
    
12.
Kuo MW, Yeh SH, Chang HM, Teng PR. Effectiveness of oral health promotion program for persons with severe mental illness: A cluster randomized controlled study. BMC Oral Health 2020;20:290.  Back to cited text no. 12
    
13.
Teng PR, Su JM, Chang WH, Lai TJ. Oral health of psychiatric inpatients: A survey of central Taiwan hospitals. Gen Hosp Psychiatry 2011;33:253-9.  Back to cited text no. 13
    
14.
Kuipers S, Boonstra N, Kronenberg L, Keuning-Plantinga A, Castelein S. Oral health interventions in patients with a mental health disorder: A scoping review with critical appraisal of the literature. Int J Environ Res Public Health 2021;18:8113.  Back to cited text no. 14
    
15.
Sekiguchi A, Kawashiri SY, Hayashida H, Nagaura Y, Nobusue K, Nonaka F, et al. Association between high psychological distress and poor Oral Health-Related Quality of Life (OHQoL) in Japanese community-dwelling people: The Nagasaki Islands Study. Environ Health Prev Med 2020;25:82.  Back to cited text no. 15
    
16.
Turner E, Berry K, Aggarwal VR, Quinlivan L, Villanueva T, Palmier-Claus J. Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand 2021;145:29-41.  Back to cited text no. 16
    
17.
Choi J, Price J, Ryder S, Siskind D, Solmi M, Kisely S. Prevalence of dental disorders among people with mental illness: An umbrella review. Aust N Z J Psychiatry 2021:48674211042239. Online ahead of print.  Back to cited text no. 17
    




 

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