25.1 Mental health for dentistry Flashcards
What are mental health impatients more likely to experience?
- 3.4 times more likely to have lost all of their teeth
- Have an average of 6 or more DMFT compared to those without mental illness
What general factors could impact people with mental illness regarding oral care?
- Low priority for dental care
- Poor motivation to attend the dentist
- Anxiety
- Smoking
- Medication
- Finances
What is schizophrenia?
Disturbance of thinking and communication on background of gradual cognitive and social decline.
Average onset for men is 21, for women is 27.
What are the positive symptoms of schizophrenia?
- Delusions
- Hallucinations (commonly auditory)
- Thought interference (the feeling that someone has put thoughts into their head or taken their thoughts away)
- Formal thought disorder (can’t understand what the person is saying)
- Motor disorder (e.g. shuffling)
- Abnormal mood states
What are the negative symptoms of schizophrenia?
- Flattened affect
- Social withdrawal
- Lack of motivation and interest
- Poverty of thought and speech
What is the relavence of schizophrenia to dentistry?
- Delusions involving teeth
- Self-neglect
- Effects of medication and interactions
- Mistrust in other people including HCPs
What are the signs and syptoms of depressive disorders?
- Low mood
- Anhedonia (reduced ability to experience pleasure)
- Lack of reactivity of mood
- Tearfulness, irritability
- Diurnal mood variation (depression worse in the morning, mood improves throughout the day)
- Anorexia and weight loss
- Loss of libido
- Fatigue
- Constipation
- Amenorrhoea
- Suicidal thoughts
- Delusional beliefs
- Self-neglect and social withdrawal
What is the relevance of depressive disorders to dentistry?
- Personal hygiene becomes difficult
- Little motivation to attend dentist
- Little care regarding the consequences of actions
- Isolation
What is bipolar I disorder?
- A condition involving episodes of mania and depression
- Strong genetic component
- Average onset early 20s
- Lifetime risk of 1%
What are the signs and symptoms of mania?
- Elated mood
- Irritability and hostility
- Emotional lability (rapid exaggerated changes in mood)
- Increased food intake
- Excess energy
- Increase libido
- Decreased sleep
- Increased spending
- Grandiose ideas
- Flight of ideas
- Quick speech
- Delusions
- Hallucinations
- Overactivity
- Distractibility
What is the relevance of bipolar I disorder to dentistry?
- May have urges for expensive dental work
- Can be very demanding
- Disinhibition (antisocial, impulsive, unwanted behaviours)
What are the signs and symptoms of anxiety?
- Palpitations
- Sweating ,shaking
- Dry mouth
- Difficulty breathing
- Feeling of choking
- Chest pain
- Agoraphobia
- Social phobia
- Generalised anxiety
- Restlessness
- Hot flushes or cold chills
- Dizziness
- Derealisation or depersonalisation
- Fears of going mad or drying
- Overlap with other conditions e.g. OCD, PTSD, panic disorder
- May have a specific phobia e.g. dental phobia
What are panic attacks?
Discrete episodes of intense fear with a variety of anxiety symptoms.
Abrupt onset, rapidly reaches a peak and lasts several minutes.
How can dental phobias be managed?
- CBT
- Behavioural therapy
- Specialist community dentist instead of GDP
- Sedation
What is somatisation?
The process by which psychiatric or psychological factors present as physical symptoms.
E.g. feeling unwell when you have a big exam coming up.
> True somatisers
Facultative somatisers
Relevance:
- Facial pain
- Preoccupation with dentures, think denture doesn’t fit right
- TMJ dysfunction (stress and anxiety)
What are the features of substance misuse?
- Alcohol: folate deficiency, bone marrow suppression
- Drugs: e.g. cocaine: erosion, cervical abrasion, gingival laceration, palatal perforation
- Smoking: periodontal disease, oral cancer
