6 - Dental management of patients with psychiatric illness

Question 1

Why are people with severe mental disorders more susceptible to oral disease?

Answer 1

• poor OH
• dental phobia
• dental cost
• difficulty accessing healthcare
• polypharmacy

Question 2

How does poor oral health impact vulnerable people?

Answer 2

• social withdrawal
• isolation
• low self esteem

Question 3

What is the impact of good mental health?

Answer 3

• improved education attainment
• greater productivity
• improved cognitive ability
• better physical health
• reduced mortality
• increased social interaction
• reduced risk of mental illness/suicide
• reduced risk behaviour including smoking
• increased resilience

Question 4

What are examples of protective factors of mental health?

Answer 4

• genetics/environmental factors
• social support/relationships
• socioeconomic status
• reduced inequality
• employment/purposeful activity
• community factors
• self esteem
• emotional/social literacy
• physical health

Question 5

What childhood factors put a person at risk for poor mental health?

Answer 5

• use of alcohol/tobacco/drugs during pregnancy
• maternal stress during pregnancy
• low birth weight
• poor parental mental health
• parental unemployment
• child abuse and other ACEs
• use of cannabis

Question 6

What adulthood factors put a person at risk for poor mental health?

Answer 6

• low income/debt
• violence
• stressful life events
• housing
• unemployment
• experience of abuse

Question 7

What is GAD?

Answer 7

Regular, uncontrollable worries about everyday life

Question 8

What is panic disorder?

Answer 8

Regular panic attack without clear cause or trigger

Question 9

What is a phobia?

Answer 9

Extreme fear or anxiety triggered by a situation or object

Question 10

What is depression?

Answer 10

Characterised by low mood, diminished interested in activity, weight gain, fatigue

Question 11

What are causes of depression?

Answer 11

• stressful life events
• family history
• giving birth
• loneliness
• alcohol and drugs
• illness

Question 12

What are dental implications of depression?

Answer 12

• chronic facial pain
• oral dysaesthesia
• TMD
• delusions associated with the mouth

Question 13

What is tardive dyskinesia?

Answer 13

• involuntary movement of tongue, lips, face, trunk and extremities
• affects patients taking antipsychotics for long periods

Question 14

What is psychosis?

Answer 14

• lose some contact with reality
• can be associated with delusions or hallucinations

Question 15

What is a delusion?

Answer 15

Strong beliefs that are not shared by others

Question 16

What is a hallucination?

Answer 16

Hear, sees, feels, smells or tastes something that do not exist

Question 17

What are causes of psychosis?

Answer 17

• schizophrenia
• bipolar
• severe depression
• traumatic experience
• stress
• drug and alcohol misuse
• physical condition ie tumour

Question 18

How can mania present in the mouth?

Answer 18

Over brushing

Question 19

How can depression present in the mouth?

Answer 19

Neglect

Question 20

What is schizophrenia?

Answer 20

• disorder of the mind that affects how you think, feel and behave
• distortions of thinking and perception

Question 21

What is a positive symptom?

Answer 21

Something that is not present in health

Question 22

What are examples of positive symptoms?

Answer 22

• hallucinations
• (paranoid) delusions
• ideas of reference
• thought disorder
• feeling of being controlled

Question 23

What is a negative symptom?

Answer 23

• withdrawal or lack of function that you would expect to see in health
• loss of normal thoughts and feelings

Question 24

What is orthostatic hypotension?

Answer 24

Drop in blood pressure when standing, can faint

Question 25

What drugs can cause orthostatic hypotension?

Answer 25

• haloperidol
• phenothiazines

Question 26

What are the dental implications of schizophrenia?

Answer 26

• drug side effects
• facial dyskinesia
• altered attitude to oral health

Question 27

What is an eating disorder?

Answer 27

• severe persistent disturbance in eating behaviour
• 5% of population affected

Question 28

What are different types of eating disorder?

Answer 28

• anorexia nervosa
• bulimia nervosa
• binge eating disorder
• avoidant restrictive food intake disorder
• PICA

Question 29

What is anorexia nervosa?

Answer 29

Self starvation

Question 30

What is bulimia nervosa?

Answer 30

Alternating dieting with compensatory behaviours

Question 31

What are dental implications of eating disorders?

Answer 31

• sialosis
• caries
• erosion
• ulceration
• halitosis
• angular cheilitis/candidiasis
• glossitis

Question 32

What support can be offered to those with anorexia?

Answer 32

• safe space to open up about condition
• simple facts
• dental support
• treat as if medically compromised

Question 33

What is SCOFF?

Answer 33

• sick
• control
• one stone
• fat
• food

Question 34

What are the SCOFF questions?

Answer 34

• do you believe you are fat when others say you are thin?
• do you worry that you have lost control over what you eat?
• do you make yourself vomit?
• would you say food dominates your life?
• have you lost more than a stone in three months?
  2 or more yes then likely eating disorder

Question 35

How is access more difficult for those with mental health?

Answer 35

• poor time keepers
• poor attenders
• chaotic lives
• cost
• may not have home address

Question 36

How should you treatment plan for those with mental health issues?

Answer 36

• realistic plan
• mindful of prevention provision
• require constant motivation
• mindful of lone working policy
• ensure consent is valid or AWI

Question 37

What additional steps can benefit those with poor mental health?

Answer 37

• bringing someone with them to appointments
• working with carers
• avoid jargon
• manage expectations
• letters to patient to aid with memory