Special focus: Dentistry and patients with mental illness

An update from Sara Hurley and Tim Kendall with a special focus on Dentistry and patients with mental illness.

Dear Colleagues

It is an unacceptable fact that people with mental ill health are disproportionately affected by poor oral health. The international evidence  is pretty stark, with the impact being both indirect (people with severe and enduring mental illness experiencing poorer oral health as a result of delayed treatment, access issues etc) and direct (the harmful effect of some symptoms of mental illness affecting oral health such as self-induced vomiting):

• People with mental illness are less likely to engage with oral healthcare, with a study finding that only 75% of schizophrenia patients brushed their teeth daily, compared to 96% in the general population.
• Poor mental health is often linked to other factors such as homelessness or substance use, which also have consequences for oral health.
• In a meta-analysis of studies, patients with severe mental illness were almost 50 times as likely to have periodontal disease;
• Patients with eating disorders had five times the odds of dental erosion. In patients with self induced vomiting, the erosion rate was seven times higher.

It is true that providing oral care for patients with severe mental illness (for example psychosis, schizophrenia, bipolar disorder) is not straightforward. However, through the use of tailored outreach and a trauma-informed approach   to supporting people with SMI - by providing an environment where a person who has experienced trauma feels safe and can develop trust - there is an opportunity to better engage with this group and, in doing so, improve oral health outcomes.

Dentistry is an important part of helping patients with mental illness improve their health and quality of life. Living with toothache or unsightly teeth can increase the risk of social isolation, lower a person's self esteem and / or create communication problems. For people with a mental illness this can be a barrier to their recovery. People with a mental illness are also affected by later cancer diagnosis and higher mortality rates, so dentistry can play an important role in addressing this health inequality - more information is included in our special focus bulletin on mouth cancer.

Understandably, not all of this can be down to the dental professional to address, but NHS dental teams can do a great deal to make a dental appointment a better experience for the patient by working with them to put reasonable adjustments in place. This might include minimising noises, distractions and the number of people in the room, or supporting the patients with specific coping mechanisms. Further detail on safety and wellbeing adaptations and techniques is included below.

For years we have campaigned to put the mouth back in the body. We hope that today's bulletin is a useful reminder to think of the mind, too.

Best wishes,

Sara and Tim

Read the full NHS dentistry and oral health update