How—and why— to integrate mental health support into the dental practice

There's a substantial link between oral and mental health, and dental professionals often undervalue their unique position to provide more holistic care that can improve their patients’ overall health and well-being, in addition to addressing mental health barriers to oral health self-care. With as many as 27 million patients seeing a dentist every year but forgoing doctor visits,¹ dentists often serve as a main entry point to the health-care system.

As emphasis grows on integrating patient care and providing a more holistic health-care experience across mental, physical, and oral health, dentists and hygienists can serve an integral role in providing education and resources on whole-person health.

You might also be interested in: Dentistry is hard. It's OK to ask for help

However, some may not be confident in their role as it relates to mental health. And many still aren’t well integrated into the referral networks and community resources more traditionally associated with addressing mental health. Still, we have the power to take proactive steps to bridge this gap.

The 8,758 hours that patients aren't in your chair

We all know that the two hours per year a patient might spend with a dentist can’t, in isolation, overcome poor health habits practiced throughout the rest of the year. But those two hours could be of extraordinary value in disrupting poor mental health trajectories that may otherwise build without interruption. When a patient is in the chair, dentists can create the opportunity to inquire about their overall well-being, especially if their oral health is declining.

Studies have long linked oral health to mental health, as physical pain or insecurity over personal appearance can exacerbate feelings of depression or anxiety, which in turn complicates chronic conditions such as heart disease and obesity. This phenomenon is particularly present in our senior communities, as shown in Delta Dental’s recent survey of more than 1,000 Americans over the age of 50.² With a backdrop of how much the mouth can affect the mind, the survey’s findings provide further insights into how older adults feel about their oral health and how it affects their quality of life:

45% of respondents shared that they are more likely to notice changes in their mood/mental health when experiencing dental pain or discomfort.
37% of those who experience signs of depression or hopelessness say oral tooth pain intensifies these feelings.

Seniors facing this battle for balance between their oral and mental health also find themselves insecure about their smiles: more than one-third said they smile less than when they were younger due to deteriorating oral health and teeth.³ Among those who indicate a higher incidence of depression and anxiety symptoms, 47% don’t like looking at their teeth in the mirror.³ Yet, 80% of all respondents say smiling can make them feel happier, which makes it even more concerning that they lack the confidence to do so.³

Seniors also face a growing problem in the United States: loneliness. With the US Surgeon General declaring loneliness an epidemic,⁴ we must pay special attention to this vulnerable and underserved population. A report from the National Academies of Sciences, Engineering, and Medicine found that one-third of adults aged 45 and over feel lonely and one-fourth of those 65 and older are socially isolated.⁵ The CDC has also shown that loneliness is associated with higher rates of depression, anxiety, and suicide.⁵ These issues the aging populations face are all compounded by changes in income, financial restraints that come with retirement, and a health-care system that can be physically and mentally taxing to access.

Reaching patients inside and out of the office

For patients already in the office, having open and honest conversations about their overall health is a potential starting point. Dentists are also well positioned to recognize concerning changes in care or patterns of oral care neglect across long spans of time, since many individuals remain loyal to their dentists for years. Some simple steps to inviting these conversations are:

Ask: If there is a change in a patient’s oral health or how they present themselves, assess the situation and ask questions. Why did they stop brushing their teeth regularly? Maybe they lost their job and daily routine. Or maybe they lost a spouse and are having a hard time coping. Your staff can also be empowered to support patient needs as they evolve over time. Consider the twice-annual appointment reminder: if your staff notices a patient who keeps pushing out an appointment or who has had a lapse in care, create an outreach plan to reconnect.

Offer: Guilt or embarrassment from falling out of an oral health hygiene routine can cause additional stress and anxiety, but you can suggest manageable steps to help them get back on track. For someone too depressed to brush their teeth, suggest they brush their teeth while sitting on the floor or couch, chew gum with xylitol, and use mouthwash frequently. If your older patients are having trouble holding a toothbrush or flossing amid aging concerns such as arthritis or disabilities, try suggesting a water flosser and a wide-handled toothbrush.

Connect: Listen carefully to identify whether your patient might benefit from being connected to someone beyond a dentist, such as a nutritionist, psychologist, etc. Connections can help in another way, too—maybe the person proactively receiving care knows of others who aren’t. Ask about their grandparents or parents—do they know the last time they went to the dentist? It’s impossible for dentists to be all-knowing individuals who track who is or isn’t in their practice—use the community to your advantage to better connect with those you cannot see.

The last step is crucial for reaching those not yet in your chair. Delta Dental’s survey found that one in four Americans 50 or older admit that the last time they went to the dentist for a routine checkup was more than two years ago.² Knowing the community is vital to understanding how to best reach those who haven’t visited in a while. Establish connections with local mental health providers and community resources, and build a network that you can tap for patients in need. Additionally, work with local senior facilities to extend your support, and offer to hold a miniclinic in a nearby long-term care facility to examine the needs of the residents, providing essential assessments that would help administrators secure care.

Dentists are a crucial component of a patient’s overall health. By actively integrating mental health support into dental practices, we can further bridge the gap between oral, mental, and physical health. If we acknowledge the entry point role that we play in our patients’ holistic health, we can better ourselves and those in and out of the chair, ultimately improving the health outcomes for our patients.

Editor's note: This article appeared in the October 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Molayem S. Dentists and doctors need to play on the same team. Nature. October 27, 2021.

2. Older Americans agree smiling could make them feel happier, but many are held back by a self-perpetuating cycle of poor oral and mental health. Delta Dental of California. May 15, 2023.

3. Smiling can ‘trick’ your brain into happiness, but depression and poor oral health holds many people back. Delta Dental. 2023.

4. New Surgeon General Advisory raises alarm about the devastating impact of the epidemic of loneliness and isolation in the United States. US Department of Health and Human Services. May 3, 2023.

5. Loneliness and social isolation linked to serious health conditions. Centers for Disease Control and Prevention. Updated April 29, 2021.