World Mental Health Day, celebrated in October, is an important reminder of the interconnectedness of our physical and mental well-being. Among the often-overlooked aspects of this relationship is the vital role oral health plays in individuals with mental health problems. This association is significant to keep in mind for those with severe mental illnesses, such as psychotic disorders.
People diagnosed with mental illnesses often face a higher risk of poor physical health, and oral health is no exception. Studies have shown that mental health and oral health may be correlated, with associations demonstrated between mental health problems, tooth loss, periodontal disease, and tooth decay.1
One study from Finland investigates the link between dental health behavior and mental health symptoms in 8,463 individuals born in Northern Finland in 1966. The study found that those with higher depressive symptoms reported brushing and visiting the dentist less frequently and perceived a greater need for dental treatment. Anxiety symptoms were also linked to less frequent toothbrushing. The results suggest that poor mental health is associated with compromised dental health behaviors.2
Research shows that interconnectedness seems to be even closer depending on how severe mental issues are. One study highlights those individuals with severe mental illnesses, particularly those with psychotic disorders such as schizophrenia, have significantly worse oral health compared to the general population. Research conducted in Sweden on outpatients with schizophrenia found that a decline in mental health correlates with an increased need for dental care. Unfortunately, those with mental health conditions often make fewer planned dental visits and report a higher number of missing teeth.3
The impact of poor oral health on mental health
The relationship between poor oral health and mental health is bidirectional, experts highlight. On one hand, mental health conditions can lead to neglect of oral hygiene. On the other hand, poor oral health can exacerbate mental health issues by affecting social interaction, self-esteem, and overall well-being.
According to The State of Oral Health Equity in America 2021 survey, those who had poor mental health were nearly four times more likely to report that they were self-conscious or embarrassed because of the condition of their teeth and problems related to their oral health than respondents with good mental health (19% versus 5%).3
Another recent study conducted in Chennai, India, states that oral health is essential for achieving a healthy, happy, and fulfilling life, particularly among young adults. Examining a sample of 84 working-aged participants, the study found that good oral health significantly contributes to psychological well-being and positively influences overall lifestyle and workplace wellness. This indicates that enhancing oral health can improve mental health outcomes, highlighting the need to integrate oral health care into broader health strategies.4
Barriers to care
Several barriers contribute to poor oral health among people with mental illnesses. These include socioeconomic factors as well as the side effects of psychiatric medications, which can cause dry mouth and further increase the risk of tooth decay and gum infections.5
One significant issue is the high cost of dental care, which can be too expensive for many people, making it challenging to access necessary treatments. Additionally, mental health conditions often lead to neglect of personal hygiene, including oral care, as individuals may struggle to maintain regular daily health routines.
Fear of dental procedures also plays a crucial role in deterring individuals from seeking regular dental care. For many, the anxiety associated with dental visits can prevent them from obtaining the treatment they need. Furthermore, oral health may not be prioritized by those dealing with immediate mental health concerns, which can overshadow the importance of maintaining good oral hygiene.5
Communication barriers between dental and health-care providers can also hinder adequate care for those with mental health problems. Effective collaboration and communication are vital to ensure comprehensive care and support for individuals with mental and oral health needs. However, many mental health services primarily focus on psychiatric symptoms, often neglecting physical health needs such as oral care. Even within health-care teams, there needs to be clarity about the responsibility of addressing a patient’s oral health.5
The risks behind oral health decline
Studies show that individuals with severe mental illnesses often have dental caries and more severe periodontal disease. This is mainly due to factors such as poor self-care, unhealthy diets, and medication side effects. However, one of the most critical side effects is drug-induced xerostomia (dry mouth), which significantly raises the risk of dental caries and gum disease.
Psychotropic medications, especially antipsychotics, often cause dry mouth as a side effect, Dr. Jukka Meurman, professor of oral and maxillofacial diseases at the University of Helsinki, says. In one of his recently published peer-reviewed studies, “Oral discomfort and health behavior of patients with typical vs. atypical antipsychotic drugs,” the emeritus professor explores the possible side effects of antipsychotic medications.6
In the study comparing patients on typical and atypical antipsychotic medications, 46% of those in the typical group and 5% in the atypical group reported persistent oral pain, primarily felt as a burning sensation in the tongue and buccal mucosa. Xerostomia was significantly more common in the typical antipsychotic group (66%) compared to the atypical group (53%). About half of the patients had visited a dentist in the past year, while professional consultations for oral symptoms were more common among women (28%) than men (17%).6
Dr. Meurman says drug-induced dry mouth symptoms occur due to medications’ anticholinergic effects, which reduce saliva production. A dry mouth can lead to various oral health issues, including tooth decay, gum disease, mouth sores, and difficulty chewing and swallowing.
“Saliva works as a crucial defense mechanism in the mouth,” the professor stresses. He emphasizes that a careful oral hygiene routine is vital, especially when a person has an underlying disease. “At their worst, patients with psychiatric problems can suffer from severe drug-induced dry mouth symptoms, making it difficult to speak and even swallow without saliva. Fortunately, cases so severe are rare,” he states.
Regular brushing, flossing, and regular antibacterial Lumoral treatment can prevent the deterioration of oral health, which, if left unchecked, can negatively impact mental well-being. Note: Lumoral antibacterial treatment is available in some European and Asian countries but is not yet available in the US.
“Patients, particularly those dealing with severe mental illnesses, should follow a comprehensive oral care regimen to mitigate issues like gum disease, tooth decay, and dry mouth caused by medication side effects. Frequent dental checkups and a focus on oral hygiene not only improve physical health but also contribute significantly to improved mental health and overall quality of life.”
Professor Meurman adds that antibacterial treatment administered at home is an excellent aid in preventing and relieving oral and dental diseases. “Adding antibacterial treatment to any oral hygiene routine enhances the effect of brushing and flossing alone.”
Good oral hygiene and regular dental visits are essential for maintaining overall health. However, traditional oral hygiene methods are not always enough. Studies show that even high-quality electric toothbrushes remove only about 65% of harmful oral bacteria, leaving behind plaque that contributes to problems both in the mouth and throughout the body.7
“Antibacterial, light-activated Lumoral therapy significantly improves traditional oral care methods, particularly when they are insufficient or when existing oral diseases require more intensive treatment than brushing and flossing alone can provide.”8
Integrating oral health in mental health services
Given the evident link between oral health and mental well-being, Dr. Meurman notes that mental health professionals should not forget the importance of oral care in their practice. This can involve simple steps, such as screening for oral health problems during routine clinical examinations, providing education about the importance of oral hygiene, and coordinating care with dental professionals.
Mental health professionals—nurses, physicians, dental hygienists, and dentists—should collaborate to provide comprehensive oral health care for patients with mental health problems. A multidisciplinary approach is essential, and oral health care should be recognized as a critical component of treatment for these patients.9
“By addressing oral health alongside mental health, we can improve the overall quality of life for people with mental illnesses, reducing their risk of chronic diseases and enhancing their social interactions and self-esteem. This would thus be a win-win situation, but it is particularly important regarding the patients’ well-being in general,” Dr. Meurman concludes.
Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
References
- Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association between mental health and oral health status and care utilization. Front Oral Health. 2022;2:732882. doi:10.3389/froh.2021.732882
- Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006;114(2):109-14. doi:10.1111/j.1600-0722.2006.00334.x
- Mishu MP, Faisal MR, Macnamara A, et al. A qualitative study exploring the barriers and facilitators for maintaining oral health and using dental service in people with severe mental illness: perspectives from service users and service providers. Int J Environ Res Public Health.2022;19(7):4344. doi:10.3390/ijerph19074344
- Prabhu DP. The link between oral health status and psychological well-being among young adults. SRM J Res Dent Sci. 2024;15(3):127-131. doi:10.4103/srmjrds.srmjrds_208_23
- Bjørkvik J, Quintero DPH, Vika ME, Nielsen GH, Virtanen JI. Barriers and facilitators for dental care among patients with severe or long-term mental illness. Scand J Caring Sci. 2022;36(1):27-35. doi:10.1111/scs.12960
- Meurman JH, Murtomaa H. Oral discomfort and health behavior of patients with typical vs. atypical antipsychotic drugs. Front Psychiatry. 2024;15:1420010. doi:10.3389/fpsyt.2024.1420010
- Aggarwal N, Gupta S, Grover R, Sadana G, Bansal K. Plaque removal efficacy of different toothbrushes: a comparative study. Int J Clin Pediatr Dent. 2019;12(5):385-390. doi:10.5005/jp-journals-10005-1669
- Pakarinen S, Saarela RKT, Välimaa H, et al. Home-applied dual-light photodynamic therapy in the treatment of stable chronic periodontitis (HOPE-CP)—three-month interim results. Dent J (Basel). 2022;10(11):206. doi:10.3390/dj10110206
- Kuipers S. Oral Health Nursing in Psychosis Care: From Knowledge to Action. Thesis. University of Groningen; 2024. https://doi.org/1088156874
