I recently greeted a patient and welcomed her into my treatment room. I inquired about any medical updates and asked how she was feeling. She paused and tried desperately to hold back tears. I held her hand as the tears streamed down her face. She told me she’d recently lost her dad, and her mom struggled with Alzheimer's.
There was massive disappointment in her voice when she told me that she was struggling to prioritize her oral health due to her mental health. She explained that she was feeling a lack of motivation to complete daily tasks, she was extremely exhausted, and she found herself wanting to isolate. I squeezed her hand and reassured her that we could devise a plan to support her oral health as she navigated the complexities of grief and caring for a loved one.
Signs and symptoms of depression
Nearly 40% of people struggle with depression.1 Depression is characterized by symptoms that last for most of the day or at least two weeks. The symptoms include feeling sad, anxious, empty, hopeless, pessimistic, irritable, frustrated, or guilty.2
Decreased energy, fatigue, loss of interest, difficulty sleeping, oversleeping, or waking up early are signs of depression.2 Another sign is losing interest in things that once held pleasure for the individual.2
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Types of depression
There are many types of depression. Major depression includes a depressed mood or loss of interest for at least two weeks, which makes the individual unable to complete daily activities.2 Persistent depression consists of less severe symptoms but persists for at least two years.2 Perinatal depression occurs during or after pregnancy. Seasonal affective disorder (SAD) comes and goes with the seasons, with symptoms typically starting in the late fall and early winter and resolving in spring and summer.2 Depression with symptoms of psychosis is a severe form of depression where a person experiences hallucinations or delusions.2 Bipolar depression involves depressive episodes where the person feels sad or hopeless, and manic moods where the person feels elevated or "up."2
Depression and oral health
No matter what type of depression a patient is experiencing, it's important to provide realistic expectations for their oral health. Daily activities such as toothbrushing can feel pointless or overwhelming when someone struggles with mental health. This doesn't mean that I tell patients they shouldn't brush; instead, I tell them to aim for brushing twice a day. If they can do only one, I tell them to brush before bed.
I also tell them to brush after they've eaten dinner. This reduces the chance of them falling asleep on the couch and skipping the nighttime brushing altogether. I instruct them to rinse with water after having sweets or acidic beverages to help support their oral pH. Implementing xylitol products, hydroxyapatite pastes, high-fluoride pastes, fluoride rinses, electric toothbrushes, baking soda rinses, and alkaline water throughout the day supports patients’ oral health.
I also implement motivational interviewing to support my recommendations. Also, we review the "in a perfect world" home care routine and the "bare minimum" routine so the patient can understand the goals of their preventive plan.
Shaming someone into compliance never works. Patients don't care how much you know unless you care about them. One of the greatest privileges in my career is to be able to support both patients and clinicians through difficult times. Receiving support during mental health struggles can be life changing. I suggest you implement compassion into every conversation, because you never know what someone may be struggling with.
References
- Panchal N, Saunders H, Rudowitz R, Cox C. The implications for Covid-19 for mental health and substance use. KFF Researchers. March 20, 2023. Accessed October 23, 2023. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
- Depression. National Institute of Mental Health, U.S. Department of Health and Human Services. Accessed October 23, 2023. www.nimh.nih.gov/health/topics/depression
