Mental health problems are on the increase, and have of late become quite topical within the NHS through recent funding pledges by the Health Secretary. The increase in prevalence of these issues are taking place in the young and adolescents and so likely to require support for their conditions throughout their lives. Unfortunately although the brain (or ‘mind’) may seem quite remote from the oral cavity there are a number of repercussions that we may need to manage. I have brought together some conditions that may manifest as a result of mental health issues with some useful papers to illustrate each. The list is no where near exhaustive-these are only some of the challenges. Outside of pure dental problems managing patient expectations on a background of mental health illness can be very difficult regardless of the treatment required.
Anti-depressant side effects and dry mouth
Prescriptions for antidepressants medications have slowly risen in the UK the last ten years or so by over 100%. The pharmacology of these drugs results in a measurable amount of xerostomia which patients may want to reduce and as a direct side effect can hasten the progress of plaque associated diseases such as caries and periodontitis. The below paper gives some information on managing dry mouth.
Parafunction, bruxism and TMJ problems have been shown to be related to anxiety, depression and stress. Dentists at a variety of different levels will be aware that TMJ issues are on the increase and patients tend to report these problems out of concern that issues may worsen. The first paper below looks at patient attitudes to their TMD whilst the second provides a stepwise plan on stabilisation splint construction.
Patients priorities and attitudes towards their temporomandibular disorders by Martin Kelleher et al.
Following on from above the highly parafunctioning patient can be difficult to manage especially where treatment is required due to the application of no-axial forces causing tooth surface loss, flexure of the teeth and their restorations. The below paper provides some insight into these issues whilst outlining options for indirect restorations in this cohort.
Demolition Experts: Management of the Parafunctional Patient: 2. Restorative Management Strategies by Neil Poyser et al.
Bulimia & Erosion
Bulimia is an emotional disorder characterised by a distorted body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by fasting or self-induced vomiting or purging.
The incidence of bulimia is increasing is on the increase largely due to the effect of obsession with self and the need to conform to ideals of body shape and weight.
Bulimia has huge implications on dentistry especially when considering tooth surface loss due to intrinsic erosion.
The following two papers the first by Milosevic provides a great overview of eating disorders while the second by Kelleher gives some guidance on management.
Introducing the Concept of Pragmatic Esthetics, with Special Reference to the Treatment of Tooth Wear by Martin Kelleher et al.
Body Dysmorphia Disorder
As a result of the penetrance of social media and so the emergence of the millenial generation body dysmorphia disorder (BDD) has become more prevalent. BDD is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others. Patients commonly worry about one specific area of their body and this is commonly but somewhat unsurprisingly the face. As the mouth is central to the face we are seeing an increase in patient requests for the correction of issues that we, as members of the profession may feel, are unnecessary and potentially harmful rather than beneficial. An excellent overview can be found below.