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Patients with severe mental illness miss out on critical dental care

A qualitative study identified reasons why dental patients with severe mental illness are at a much higher risk of having oral health problems. (Image: Shutterstock/Elnur)

YORK, UK: Patients who struggle with severe mental illness (SMI) are three times more likely to face total edentulism than the general population, according to a new study by researchers at the University of York. The qualitative study, which was conducted through interviews with both service providers and patients, highlighted the existence and causes of significant inequalities in oral health and suggested changes that could be made by the National Health Service (NHS).

Dr Masuma Mishu, an epidemiological researcher at the University of York and lead author of the study, said in a press release, “People with severe mental illness have poorer oral health compared to those without mental illness and untreated tooth decay is a common cause of non-psychiatric hospital admissions for this group. Our study addresses the urgent need to understand the reasons behind these oral health inequalities.”

Seven participants with severe mental illnesses, such as schizophrenia, schizo-affective disorder or bipolar disorder, were interviewed, in addition to ten healthcare professionals, including carers, dentists, nurses and doctors. Participants in the former group cited the most significant barriers to maintaining good oral health as being a general struggle to take care of their overall health owing to SMI, limited finances, and difficulty in finding an NHS dentist within a reasonable distance who would not drop them as a patient for missing appointments owing to their mental health. In addition, patients noted a need for a dental care provider they could trust, particularly one who was trauma-informed and generally educated on psychological issues.

The group of healthcare providers interviewed made a number of suggestions for improving the patient experience for those with SMI. These suggestions included improved communication with patients, acknowledgement of the patient as a whole, development of a tailored approach for each patient and inclusion of the patient’s carer in their oral healthcare plan. The healthcare providers noted that problems such as missed appointments and high caseloads caused discontinuity of care.

The study’s co-author, Prof. Lina Gega, who teaches in the Department of Health Sciences at the University of York, said: “We are calling for oral health to be incorporated into care planning for those experiencing severe mental health problems. Offering support such as organised accompanied visits to the dentist can help alleviate anxieties and overcome practical barriers around dental check-ups and treatment.”

Dr Mishu outlined a plan for helping NHS healthcare providers create a new culture in which they can better discuss oral healthcare and engage with patients with SMI. She explained: “Working closely with service users, carers, public health researchers and partners in the NHS, we want to co-design a system-level intervention for people with severe mental illness. This will be designed to encourage training and the provision of collaborative support from both mental and dental healthcare staff. We aim to provide comprehensive tailored support—from encouraging personal oral healthcare to arranging accompanied dental visits and help with paperwork allowing patients to access additional funding.”

The study, titled “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”, was published on 5 April 2022 in the International Journal of Environmental Research and Public Health.

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