Oral care important for mental health patients

Patients can shy away from looking after their teeth, which leads to more serious conditions, writes Karen-Leigh Edward.

The importance of special attention to oral problems for people with mental disorders can’t be stressed enough since the lifespan of people with serious mental disorders is shortened compared with the general population.

Physical health management in a mental health service environment has been identified as a COAG priority in the National Standards for Mental Health Services developed in 2010.

This shift is due to the high incidence of chronic physical conditions among people with a diagnosis of mental illness as compared to those who do not (approximately 2:1). For people who experience mental illness there are also barriers to seeking and accessing general medical and dental care, such as cost and stigma.

While general medical care is available in Australia through reimbursement via the Medicare Benefits Scheme (MBS), dental or oral care is considerably less accessible without the available funds or having personal private health cover.

Mental health clients will often deny a toothache or infection, or postpone oral care due to lack of affordability or unsatisfactory prior encounters with dental professionals, experience avolition and other symptoms of mental illness that can affect motivation and ability to follow up on oral health, and experience excessive salivation or a dry mouth as a consequence of psychotropic medications. Additionally a compromised oral state can cause feelings of humiliation and discrimination.

Importantly, poor oral health can lead to an increase in morbidity, such as heart disease and even death. Research undertaken in 2010 and published in the British Medical Journal highlighted the significant increase in the development of heart disease in people who only brushed once per day confirming a link between oral health and heart disease. The study of 11,000 adults in Scotland showed that people who only brushed their teeth once a day had a 70 per cent increased risk of developing cardiovascular disease.

Oral health can be positively impacted upon by routine oral (not dental) assessment undertaken by nursing staff, although in routine practice is considered non-essential nursing care in some areas of health. Routine oral care for hospitalised patients is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.

Oral health interventions are generally low cost and easily accessible and readily adaptable to routine nursing care and can greatly reduce oral disease.

Karen-Leigh Edward is associate professor of Nursing Research at the Australian Catholic University and director of St Vincent’s and Mercy Private’s Nursing Research Unit.

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