We’re still talking about mental healthFeatured Products Promotional Features
Posted by: The Probe 22nd June 2022
All of us, at one time or another, will feel sad, lonely or overwhelmed, but not everyone will experience a mental illness. Whereas the term mental health refers to “a state of wellbeing in which every individual (…) can cope with the normal stresses of life, work productively and make a contribution to their community,” mental illness encompasses a range of disorders, from anxiety and depression to conditions like schizophrenia. [i]
The key to protecting wellbeing is knowing when to ask for help, or to step back, or to try to change whatever it is in our life that is making us stressed/anxious/low etc., but during the pandemic some of the tools that we can use to manage our mental health were taken away. Unsurprisingly, Covid saw a massive rise in the number of people reporting problems and there are millions waiting for specialist treatment.[ii] Pandemic restrictions in the UK have lifted, but 2022 soon bought different horrors, and reasons to feel helpless and scared by the world. If wellbeing means the ability to cope with the ‘normal’ stresses of life, the last two years have been anything but.
With increased prevalence, dental teams will be seeing more oral health impacts of poor mental health/mental illness during routine consultations. Often, the neglect of personal hygiene, including mouth hygiene, particularly in someone who is normally meticulous, can be a sign of a problem. Also, evidence of behaviours like smoking. Someone may start, or restart a smoking habit to manage stress, believing that the nicotine ‘hit’ is relaxing them, when it can actually increase anxiety and tension.[iii] Smoking has a catastrophic impact on general health and is the number-one factor for oral cancer, as well as being linked to periodontal disease and the staining our patients hate. Smokers should be supported in their efforts to quit and encouraged to attend regular consultations and hygiene appointments, to monitor for issues as well as keep the mouth scrupulously clean.
Drinking alcohol to excess is often used in the same way as smoking, to ‘take the edge off’, or mask anxiety, and stop an individual thinking about what’s bothering them. But the side-effects of too much alcohol, including disrupted sleep, or worrying about how they’ve behaved, make matters far worse. From an oral health perspective, patients who regularly drink increase their risk of developing oral cancers, can increase their likelihood of tooth decay and erosion due to alcohol being full of sugar and some drinks being highly acidic too. Recreational drug use also often increases as a result of mental health problems. Cannabis can lead to oral leukoplakia, may cause gingival enlargement and often gives the user dry mouth potentially leading to other dental diseases. Ulcerative oral lesions can indicate and be a symptom of cocaine use, prolonged cocaine use can cause tooth wear and have significant orofacial effects.[iv] Some medications for mental illness also come with a side effect of dry mouth.
Other patients may be trying to manage their feelings with disordered eating. There are a range of oral complications associated with eating disorders, for example unusual patterns of toothwear due to purging/vomiting.[v] For a patient suffering from anorexia nervosa, complications include “severe lingual-occlusal erosion, (…) buccal erosion, (…) also subnormal values of saliva properties, owing to dehydration.”[vi] The binge cycle of eating disorders tends to involve excessive intake of high-sugar carbohydrate. Also, to mask the signs of purging/vomiting, they may be brushing over-zealously, which can again lead to higher-than-expected wear.
Every patient who you know, or suspect has poor mental health or a mental illness, they may choose to talk to you. Regardless, make them feel comfortable and communicate with empathy. A patient might also feel ashamed of their dentition, or oral hygiene, which is making them stressed or socially withdrawn. There are solutions you can suggest, including restorative treatment which is highly conservative and can be lifechanging – and is often more affordable than they think. Give them practical lessons in how to keep their mouth lovely and clean, which will make them feel a bit more ready to face the world. Show them how to hold the brush correctly, how much pressure to use and how to clean interdentally, to get rid of all hidden food deposits and bacteria. TANDEX has a range of high-quality brushes and adjuncts, including mouthwashes, also interdental tools, like its WOODI brush with birchwood handle which are all easy and pleasant to use.
Regarding mental wellbeing and illness, there is still a gulf between talk, and action. With all health and social care services under strain, access may be nigh on impossible for some, others may not want to bother their GP. We are learning more about mental health, including the importance of looking out for colleagues and talking care of ourselves. With tailored preventive care, we can help patients and, in some cases their families and carers too. Perhaps most importantly we can be a friendly face and a positive presence to support them in their return to health and wellness.
Author Kimberley Lloyd- Rees on behalf of Tandex
Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.
[i] Mental health: strengthening our response. WHO, 30 March, 2018. Link: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response (accessed March 2022).
[ii] Millions in England face ‘second pandemic’ of mental health issues. Guardian, 21 February 2022. Link: https://www.theguardian.com/society/2022/feb/21/england-second-pandemic-mental-health-issues-nhs-covid (accessed March 2022).
[iii] Smoking and mental health. Mental Health Foundation. Link: https://www.mentalhealth.org.uk/a-to-z/s/smoking-and-mental-health (accessed March 2022).
[vi] HELLSTRÖM, I. (1977), Oral complications in anorexia nervosa. European Journal of Oral Sciences, 85: 71-86. https://doi.org/10.1111/j.1600-0722.1977.tb00535.x
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