Why does patient mental health matter? Part 4: non-carious tooth surface loss as a consequence of psychiatric conditions

Abstract

This is the fourth article in a series looking at psychiatric presentations in dentistry. Recently, the oral health of people with severe mental illness (SMI) has gained significant media attention after the Office of the Chief Dental Officer for England published a statement on the importance of prioritizing oral health for people with SMI. Furthermore, a consensus statement has set out a 5-year plan to improve oral health in people with SMI. In Part 3, we discussed how a psychiatric disorder can result in dental pathology primarily through self-neglect. This article explores tooth surface loss and the potential link with psychiatry, considering the role of the primary dental care team in early recognition of psychiatric presentations. A fictionalized case-based discussion is used to explore this concept. CPD/Clinical Relevance: This article emphasizes the role of the primary care dental team in recognition of psychiatric conditions, such as eating disorders.

College News

“…The dental professional is responsible for ensuring optimal oral health but should also be alert to possible severe mental illness in individuals attending with unusual dental presentations. [8][9][10][11] They must also be aware that people with psychosis are a high-risk group for poor oral health including oral cancer. Finally, commissioners need to prioritise dental access for people with severe mental illness as a vulnerable group, for instance ensuring the availability of free or subsidised care.…”

“…They can adopt a whole-person approach in managing the impact of poor oral health on severe mental illness, particularly in relation to social avoidance from poor oral health outcomes related to bad breath and poor aesthetics. And they can be aware of dental presentations of severe mental illness which can alert to a possible diagnosis, and provide immediate onward referral to mental health services if severe mental illness is suspected from dental presentations [8][9][10][11].…”