Posted on 20 May 2022
The study explores the reasons why people with severe mental illness – such as Schizophrenia and bipolar disorder – struggle to maintain good oral health and access dental care, leaving them three times more likely than the general population to lose all their teeth.
The research found a lack of integration of oral, mental and physical health care services and lack of tailored support for accessing dental care to be contributing factors.
The study highlights the need for mental health care staff to provide support for good oral health. Dental care providers would also benefit from training to increase their knowledge of the needs of people with severe mental illness, the research suggests.
Availability of care was flagged by the study as a major issue with recent reports suggesting as many as nine out of ten NHS dental practices in England are now closed to new routine patients.
Lead author of the study Dr Masuma Mishu from the Department of Health Sciences at the University of York, said: “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.”
Co-author of the study, Professor Lina Gega from the Department of Health Sciences at the University of York, added: “During a mental health crisis, physical health can be overshadowed; this includes oral health which can lead to long-term dental problems, pain and oral disease.
“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.”
The qualitative study involved seven participants with severe mental health conditions. A further ten participants were healthcare professionals including dentists, carers, mental health nurses and doctors.
Participants in the study also identified costs as a key barrier to accessing dental care.
One participant with a diagnosis of bipolar disorder said: “Because it’s having access to quality dental care and if it’s costing you 45 quid to go now and a bit of a squirt and clean 45 quid is, you know well that’s Monday, Tuesday, Wednesday, Thursday’s benefits for me well what shall we not pay? Shall we not pay my rent, shall we not pay my council tax; so I am not going to see my kids, yeah; no, I am okay with brown teeth and a bit of plaque. You know you’re asking people to make those sort of choices.”
The researchers are now seeking further funding inorder to trial interventions co-designed with multiple stakeholders.
Dr Mishu added: “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 health care staff. We aim to provide comprehensive tailored support - from encouraging personal oral health care to arranging accompanied dental visits and help with paperwork allowing patients to access additional funding.
“Overall this will promote a culture of discussing oral health care in mental health care settings and will enable people with severe mental illness to engage and learn about good oral health”.
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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 is published in the International Journal of Environmental Research and Public Health. The study was led by researchers at the University of York and was funded by Closing the Gap Network.