Understanding the importance of oral health in psychiatric patients

Dental disease and psychiatric illness are among the most prevalent health problems in the Western world. While the dental needs of mentally ill people are similar in type to those in the general population (Markette et al, 1975) there is some evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health (Stiefel et al, 1990; Armstrong, 1994). Sims (1987) reports that physical health problems are more common in psychiatric patients. They seem to be poorly recognised by psychiatrists, and oral health is no exception (Hede, 1995). Oral health is an important aspect of quality of life which affects eating, comfort, speech, appearance and social acceptance (Nordenram et al, 1994). The two diseases which have a major impact on the oral cavity are dental caries (tooth decay) and periodontal disease (gum disease). Dental caries is an infective process, which may potentially destroy all exposed tooth surfaces. It is caused by acid produced by micro-organisms which colonise dental plaque, the soft layer which accumulates on the tooth surface. Dental plaque is also a key determinant of periodontal disease. Daily removal of plaque by tooth-brushing, particularly with toothpaste containing fluoride, plays an important part in maintaining oral health. Routine dental health care for psychiatric patients was previously provided within many of the large institutions. Since the introduction of community care, patients have increasingly been given respon sibility for arranging their own dental care, usually with a general dental practitioner. The move towards independence means that patients need a greater understanding of the potential risks of dental dis ease. This article aims to raise awareness of oral health issues in psychiatric patients and to promote better dental care for the mentally ill. Even those without natural teeth will need a range of dental services. We feel that there is a duty of care to prevent deterior ation of dental health in this vulnerable group.