6 - Dental management of patients with psychiatric illness Flashcards
Why are people with severe mental disorders more susceptible to oral disease?
- poor OH
- dental phobia
- dental cost
- difficulty accessing healthcare
- polypharmacy
How does poor oral health impact vulnerable people?
- social withdrawal
- isolation
- low self esteem
What is the impact of good mental health?
- 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
What are examples of protective factors of mental health?
- genetics/environmental factors
- social support/relationships
- socioeconomic status
- reduced inequality
- employment/purposeful activity
- community factors
- self esteem
- emotional/social literacy
- physical health
What childhood factors put a person at risk for poor mental health?
- 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
What adulthood factors put a person at risk for poor mental health?
- low income/debt
- violence
- stressful life events
- housing
- unemployment
- experience of abuse
What is GAD?
Regular, uncontrollable worries about everyday life
What is panic disorder?
Regular panic attack without clear cause or trigger
What is a phobia?
Extreme fear or anxiety triggered by a situation or object
What is depression?
Characterised by low mood, diminished interested in activity, weight gain, fatigue
What are causes of depression?
- stressful life events
- family history
- giving birth
- loneliness
- alcohol and drugs
- illness
What are dental implications of depression?
- chronic facial pain
- oral dysaesthesia
- TMD
- delusions associated with the mouth
What is tardive dyskinesia?
- involuntary movement of tongue, lips, face, trunk and extremities
- affects patients taking antipsychotics for long periods
What is psychosis?
- lose some contact with reality
- can be associated with delusions or hallucinations
What is a delusion?
Strong beliefs that are not shared by others
What is a hallucination?
Hear, sees, feels, smells or tastes something that do not exist
What are causes of psychosis?
- schizophrenia
- bipolar
- severe depression
- traumatic experience
- stress
- drug and alcohol misuse
- physical condition ie tumour
How can mania present in the mouth?
Over brushing
How can depression present in the mouth?
Neglect
What is schizophrenia?
- disorder of the mind that affects how you think, feel and behave
- distortions of thinking and perception
What is a positive symptom?
Something that is not present in health
What are examples of positive symptoms?
- hallucinations
- (paranoid) delusions
- ideas of reference
- thought disorder
- feeling of being controlled
What is a negative symptom?
- withdrawal or lack of function that you would expect to see in health
- loss of normal thoughts and feelings
What is orthostatic hypotension?
Drop in blood pressure when standing, can faint
What drugs can cause orthostatic hypotension?
- haloperidol
- phenothiazines
What are the dental implications of schizophrenia?
- drug side effects
- facial dyskinesia
- altered attitude to oral health
What is an eating disorder?
- severe persistent disturbance in eating behaviour
- 5% of population affected
What are different types of eating disorder?
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- avoidant restrictive food intake disorder
- PICA
What is anorexia nervosa?
Self starvation
What is bulimia nervosa?
Alternating dieting with compensatory behaviours
What are dental implications of eating disorders?
- sialosis
- caries
- erosion
- ulceration
- halitosis
- angular cheilitis/candidiasis
- glossitis
What support can be offered to those with anorexia?
- safe space to open up about condition
- simple facts
- dental support
- treat as if medically compromised
What is SCOFF?
- sick
- control
- one stone
- fat
- food
What are the SCOFF questions?
- 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
How is access more difficult for those with mental health?
- poor time keepers
- poor attenders
- chaotic lives
- cost
- may not have home address
How should you treatment plan for those with mental health issues?
- realistic plan
- mindful of prevention provision
- require constant motivation
- mindful of lone working policy
- ensure consent is valid or AWI
What additional steps can benefit those with poor mental health?
- bringing someone with them to appointments
- working with carers
- avoid jargon
- manage expectations
- letters to patient to aid with memory
