A number of studies have demonstrated that oral health is poorer in people who have experienced a mental health disorder (PMD). Although more research has hospitalised groups or those with severe problems with fewer papers focused on those in the community or outpatients.
The aim of this review was to analyse current published work on barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders and address it from individual, organisational and systemic perspectives.
Methods
Searches were conducted in the Medline, Web of Science, ERIC and Psychlit databases. A narrative review of papers focusing on actual barriers and enablers rather than theoretical or envisaged ones was undertaken. Systematic reviews were prioritised. The review was undertaken with the consideration that placing more responsibility and burden on individuals to meet their oral health needs was not likely to be effective for those with mental health disorders.
Results
- Published work reflects the concerns and challenges in ensuring good oral health outcomes for PMD.
- PMD are often concurrently dealing with many life challenges including poverty, unemployment or underemployment and the many related burdens such as insecure housing and social isolation. They are often vulnerable because of lifestyle and health habits including poor diet, cigarette smoking and substance abuse.
- There is consistent evidence about poorer oral health outcomes in PMD and side effects of medication increase risk of dental disease.
- Fatigue and lack of motivation for proper oral hygiene and health care habits and poor psychosocial functioning adds to inadequate oral hygiene routines with a much lower tooth brushing rate among many PMD compared with the general population.
- At an individual level
- poorer use of dental services for PMD related to stigma, feelings of shame, helplessness
- and low self-esteem; lack of income and health insurance; dental fear, anxiety and phobia; and restlessness in the dental waiting environment and mistrust of dental professionals and health care providers
- Lack of what dental services were available and what government or health insurance would cover.
- Difficulty in accessing services – service costs
- do not perceive the need for oral health care
- Treatment postponed until pain was severe
- Organisational level
- Oral care for hospitalised PMD is variable and not routinely assessed
- Lack of knowledge and time in demanding care environments and their oral health initiatives
- Few dentists appear adequately prepared in providing care to patients with mental health disorders, and vice versa, with mental health professionals uncomfortable with and often ignoring oral hygiene in PMD.
- mental health patients are often late or fail to attend appointments
- Systemic level influences
- lack of inter professional integration between dental services and general medical and mental health services.
- oral health of PMD appears to have worsened with the move from institutional to community-based care.
- There is limited published work on enablers for achieving access to dental care and good oral health outcomes in PMD, and much of what does exist focuses on ideal rather than actual enablers.
- The published work provides little empirical data regarding barriers to accessing care and oral health outcomes for this group, or detailed qualitative information.
Conclusions
The authors concluded: –
The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.
Comments
This narrative review from researchers in Australia provides a good overview and discussion of the barriers to good oral health care faced by patients with mental health disorders. As the authors note the bulk of the published work relates to barriers to dental care with little on enablers and interventions to improve oral health and dental service provision to this group of patients. Improved inter professional and integrated oral health/mental health care in one option but as the authors note the process how this is implemented and resourced is key. In the UK the development of the speciality of Special Care Dentistry which includes PMD within it remit should play a part in an such an integrated inter professional network to improve care for this group. However, as the authors suggest a range of options for care is needed involving education and partnership working with health professionals, carers and those with PMD.
Links
Primary paper
Slack-Smith L, Hearn L, Scrine C, Durey A. Barriers and enablers for oral health care for people affected by mental health disorders. Aust Dent J. 2017 Mar;62(1):6-13. doi: 10.1111/adj.12429. Epub 2017 Feb 1. Review. PubMed PMID:27164018.
Other references
Dental Elf – 7th Aug 2017
Dental Elf – 13th Jun 2016
