Dr. Asiya Awan
With mental health issues still being stigmatized in our society, how long do we have to go, to reach the point where not only we accept existence of mental disorders but also learn to identify the other health problems associated with it.
The issue of oral hygiene maintenance and emergence of dental problems in psychiatric patients is never much talked about. However, it’s one of the serious disease burdens on our public health system. It affects and alters the quality of lives of an already suffering population. Neglecting this important aspect of oral health increases the cost of treatments required for the patients.
On the other hand, how inclusive is our Pakistani dental healthcare system? In psychiatric patients, types and disabilities vary from mobility impairment to difficulty with dexterity. Some of the mental and psychological health disorders including bipolar disorder, Schizophrenia, Autism spectrum, Attention deficit hyperactive disorder, anxiety, depression, Obsessive Compulsive Disorder, Bulimia and Anorexia Nervosa, all may contribute to various oral problems. Deterioration of gum and jaw bone health, teeth cavities, erosion and attrition of teeth resulting in enamel wear off and resultant tooth sensitivity, mouth ulcers are few to name. Bulimia Nervosa cause craters in teeth enamel because of vomiting and acid reflux in mouth. Gum recession and sensitivity can be due to habitual vigorous brushing in obsessive compulsive disorder.
What Research Reveals?
A two way association has been found between oral health and mental health. Also, an association has been found between edentulism (complete loss of all natural teeth) and DMFT (decayed, missing, filled teeth) and serious mental disorders.
Many social determinants of health impact people suffering from mental disorders. These include unemployment, poverty, uncertain availability of food and shelter, social stigmatization and isolation. These issues are also significant risk factors/indicators for poor oral health.
Poor oral health in people with mental disorders is associated with poor dietary habits and poor nutrition, excessive use of sugary drinks, substance misuse (paan, chaalia, ghutka, alcohol), adverse effects due to anti-psychotic and anti-depressant and other medications. Simultaneously, difficulty in accessing health care facilities due to cost and social barriers.
Incorporation of dental health education and promotion amongst community settings and especially patients suffering from mental health issues is lacking. This lack of dental education adds to the disease burden of an already struggling developing country. A lot of effort and resources are required in absence of timely intervention. It increases the number of stakeholders; the patients, dentists, hospitals, private and public. Health Promotion is about highlighting health issues timely to create awareness and reduce the burden. On the other hand, the psychological impact of having a bad dentition is immense. Missing teeth due to trauma, caries or irregular or yellow stained teeth with bleeding, swollen gums, halitosis, irregular teeth can result in low self-esteem and depression in all cohorts of age. Oral health problems can cause social anxiety, affect jobs careers and hinder promotions.
Another problem concerning psychology and affecting oral health is addictions. Addictions could be a consequence of disturbed psychological state. Presently, vaping (e-cigarrette) is becoming popular in teenagers belonging to the elite class. This can have detrimental effects on oral health. It can lead to proliferation in mouth bacteria resulting in tooth decay and gum disease. Lower social class especially indulges in pan, gutka, cigarette. This may result in pre-carcinogenic changes such as dysplasia or oral luekoplakia. It may eventually lead to oral carcinoma.
Conclusion and Recommendations
With not much studies done in this regard it is recommended to devise a dental health program for this important but neglected segment of population i.e. sufferers of mental and psychological illnesses. This would mean reducing the disease burden and also reducing risk of treating patients by putting them into general anesthesia.
A forum is urgently required to initiate the theoretical framework incorporating all stakeholders including service providers dental and mental health practitioners, caregivers, consumers, representatives, policy makers and other Government and private organizations working for public health. Engaging all stakeholders including patients will help understand and design evidence based intervention for the unmet needs in this area. So it is carried out not just conceptually by context but tried with different approaches with trial and error to come up with the best.