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Feb 166 min read

Why is mental health in Dentistry so important?

By Rumasya Omer





The General Dental Council’s first principle out of nine is to ‘put patient’s interest first’ (1). In order to do this, we must consider all aspects of a patient's health including their mental health in accordance with the WHO definition of health(2). How would achieving a high quality of care be possible if we are unable to have a holistic approach to a patient's needs? 

This article explores why caring for a dental patient's mental and emotional needs should be a top priority. It also analyses the benefits of caring for a patient's mental well-being and suggests techniques that dental professionals could consider using to adapt their care while dealing with patients struggling with mental illnesses.


Dental Phobia is a prominent issue in the field of oral healthcare. Surveys carried out about Dental Phobia shows that up to 53% of the UK’s population have a fear of the dentist and 17% admit that they refuse to attend appointments due to this(3). I witnessed this during my work experience in the case of an elderly patient seeking a tooth extraction. The dentist explained clearly how the procedure would take place and immediately recognised the unease the patient displayed despite having not verbally stated they were anxious. The dentist adapted his methods by establishing an open line of communication with the patient and talking to them calmly about their fears, thus clearing any doubts about the procedure. He then allowed the patient a minute outside of the room to breathe and gather their thoughts before returning much more relaxed. This was very effective as the dentist recognised the patient’s emotional needs and acted to make the patient feel more comfortable. By addressing patients’ fears and concerns head on, dentists can help patients feel safer and more willing to undergo necessary treatments which enhances their quality of life. In addition, it stops health problems from ‘snowballing’ into a major complication which could in turn have detrimental effects if left untreated. The importance of acknowledging patients’ emotional needs could have a profound effect on their mental and oral health in the long term as well as the short term.


Caring for patients’ mental health is essential and will establish a good relationship between dentist and patient. Considering all aspects of the patient’s health (physical and mental) conveys a strong level of empathy and understanding. Overtime, through discussing their emotional wellbeing patients will become more trusting of their dentist. In addition to this, it enhances the quality of treatment as the dentist is able to take into account if the patient suffers from any mental illnesses and work with them to produce the best course of action to treat their dental issues. This strengthens the patient-provider relationship and increases patient satisfaction as they know that the course of treatment is best suited for their personal needs. I experienced this first-hand when I broke one of my incisors. When seeking dental help, I expressed how much my self-confidence had been affected as I no longer felt comfortable talking or smiling in public. The dentist showed compassion and clearly explained the treatment options. He explained that with my young age, it would not be suitable to do a veneer or a crown and the best option for me was bonding. We built a plan together both for the short term and a more permanent solution as I got older keeping in mind my social anxiety. This clearly demonstrates how important it is to take into account patients’ emotional needs, as it increases their self-confidence, hence also improving satisfaction.


 Many dental problems could be linked to psychological or emotional factors and consequently can identify underlying mental health issues. In patients with self-induced vomiting, the erosion rate is seven times higher(4) and 35–38% of all who experience eating disorders will present with dental erosion which is easily identified by a dental professional (5). Secondary to bulimic behaviour, there can be bilateral salivary gland swelling. A discussion with the patient would be then needed not only on their required dental treatment but also gaining specialist help to recover from their eating disorder. Additionally, attrition through comorbid issues of bruxism is common among patients with anxiety(6). Attrition is the loss of tooth structure or tissue caused by tooth-on-tooth contact and occurs in 1 in 3 adolescents(7)(8). Bruxism, more commonly known as teeth grinding, can lead to other health problems such as sleep apnea and temporomandibular joint disorders within your jaw. It is imperative, if identified, for a dental professional to ask the patient about their mental health in order to gain a good understanding of the root of the issue. Following this, the dentist must explain that bruxism often stems from anxiety and warn the patient of future problems it can cause in case the patient is unaware of the extent of their stress.

Similarly, there can be a direct correlation between the severity of depression and the severity of periodontitis (5). If a patient has already stated that they have depression, the dentist can work with the patient to prevent the periodontitis from worsening by referring them to a periodontist. Antidepressants often make patients more susceptible to Xerostomia (diminished saliva production, causing oral dryness) and the patient’s dental condition may be exacerbated by heavy tobacco, alcohol and caffeine use which could also be linked to their mental health issues(9) (5). Therefore, it is crucial for a dentist to be notified of the patient’s mental health and the medications to appropriately tailor their treatment plan. A dentist can often be at the forefront in identifying a mental health issue and could play a pivotal role in aiding the patient back to health. By addressing these underlying issues, dental professionals can provide more effective and lasting solutions, therefore overall better oral and mental health outcomes.


Health inequalities faced by patients with mental illnesses have become increasingly problematic. The NHS states that health inequalities are ‘unfair and avoidable differences in health across the population, and between different groups within society. These include how long people are likely to live, the health conditions they may experience and the care that is available to them.’ (10). As a result of delayed treatment, people with ill mental health are disproportionately affected by poor oral hygiene(11). They tend to avoid dental care to the extent that their oral hygiene is neglected which can lead to periodontal disease and caries. It is commonly known that patients may be anxious to seek help for their dental issues as they are afraid of their mental illness being identified by a professional. They are also less likely to seek help because they are insecure about their poor oral hygiene and are afraid of judgement from dental professionals. In addition to this, dental conditions were the fourth most common reason for avoidable hospital admissions in people with severe mental illness(11). This concept can be compared to that of a domino effect; not only do their dental issues worsen as a result of delayed treatment, but they have also not received help for the mental illness either, which leads to further insecurities as their dental condition worsen due to lack of professional help.


 Dental professionals can adapt by using techniques to help patients with mental illness. For example: minimising noises and distractions, limiting the number of people in the room and detailed conversations including all the information about their treatment. Some patients will benefit from a stop signal being used during a procedure to gesture when they are uncomfortable. A dental professional can also suggest mindfulness techniques like listening to music and breathwork. Having a close liaison with the patient and other healthcare professionals involved in their treatment can help as they can identify any changes in medication and their effects on the patient and conversely, the dentist can give feedback if they notice a change in the patient’s symptoms to prevent exacerbation of their mental illness. Lastly, the use of general anaesthesia can allow anxious patients to be more comfortable(11).

 We can conclude that caring for a patient’s emotional and mental health needs should be integral to providing holistic care as a modern dental professional. Focusing on these patient needs will enhance patient care, allowing the patient to feel safe and most importantly it will increase trust in the dental profession. With mental health issues on the rise, now more than ever, we should be focusing on caring for the emotional needs of our patients to ensure the best possible outcome of treatment.


BIBLIOGRAPHY

1) General Dental Council (2019). General Dental Council - Focus On Standards. [online] gdc-uk.org. Available at: https://standards.gdc-uk.org/.

2)Huber, M., Knottnerus, J.A., Green, L., Horst, H. v. d., Jadad, A.R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M.I., Meer, J.W.M. v. d., Schnabel, P., Smith, R., Weel, C. v. and Smid, H. (2011). How should we define health? BMJ, [online] 343(343), pp.d4163–d4163. Available at:https://doi.org/10.1136/bmj.d4163.

3)Anxiety UK. (n.d.). How Common Is Dental Anxiety and What Can You Do About It (advertorial blog). [online] Available at: https://www.anxietyuk.org.uk/blog/how-common-is-dental-anxiety-and-what-can-you-do-about-it-advertorial-blog/.

4)Anon, (2023). The right to smile – College of General Dentistry. [online] Available at: https://cgdent.uk/2023/06/22/the-right-to-smile/#:~:text=In%20a%20meta%2Danalysis%20of.

5)Dental Update. (n.d.). Dental Update - Why does patient mental health matter? Part 1: The scope of psychiatry within dentistry. [online] Available at: https://www.dental-update.co.uk/content/psychiatry-within-dentistry/why-does-patient-mental-health-matter-part-1-the-scope-of-psychiatry-within-dentistry/#:~:text=The%20mental%20health%20of%20dental.

6)Preparing for practice. (n.d.). Available at: http://www.gdc-uk.org/docs/default-source/quality-assurance/preparing-for-practice-%28revised-2015%29.pdf [Accessed 29 Jul. 2023].

8)Casanova-Rosado, J.F., Medina-Solís, C.E., Vallejos-Sánchez, A.A., Casanova-Rosado, A.J., Maupomé, G. and Avila-Burgos, L. (2005). Dental attrition and associated factors in adolescents 14 to 19 years of age: a pilot study. The International Journal of Prosthodontics, [online] 18(6), pp.516–519. Available at: https://pubmed.ncbi.nlm.nih.gov/16335172/.

9)Talha, B. and Swarnkar, S.A. (2023). Xerostomia. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545287/#:~:text=Xerostomia%20refers%20to%20the%20sensation.

11)www.dental-nursing.co.uk. (n.d.). NHS dentistry and oral health update: patients with mental illness - DentalNursing. [online] Available at: https://www.dental-nursing.co.uk/news/nhs-dentistry-and-oral-health-update-patients-with-mental-illness.


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