While it may not be widely understood, there is a clear connection between a person’s dental health and their mental health. Numerous studies have identified associations between mental health and oral health¹, however, the interaction often does not get much attention, even among health care professionals. Writing in a recent Psychiatric News article, Antoinette V. Shappell, M.D., Pierre M. Cartier, D.M.D., M.P.H., note that “psychiatrists well understand the need to be aware of all of their patient's health issues, but sometimes oral health gets overlooked⁵.”

Shappell and Cartier point out the various ways in which oral health and mental health are interconnected, each having an impact on the other. Dental health problems can impact a person's quality of life and exacerbate mental health problems. For example:

• When a person has poor oral health, it can impact their eating, speech and self-esteem and lead to reduced social interactions, further harming mental well-being.
• Many people, including people with mental health conditions, have anxiety associated with dental care and procedures and avoid needed care, but chronic oral pain can contribute to poor mental health and make treating mental health conditions more difficult.
• Symptoms of mental illnesses can contribute to poor nutrition which in turn contributes to poor dental health.
• People with mental illness, particularly those experiencing symptoms of serious mental illness, may have difficulty maintaining an effective daily dental care routine and accessing needed dental treatment.

Shappell and Cartier highlight four key dental conditions seen in patients with psychiatric disorders: tooth decay, gum diseases, dry mouth (xerostomia), and teeth grinding (bruxism). Dry mouth can be a complication of anxiety and is a side effect of many psychotropic medications. They suggest that over-the-counter products (such as oral moisturizers, mouth rinses, toothpaste or xylitol gum) can be helpful for dry mouth. Teeth grinding, which can damage teeth and contribute to teeth and jaw pain, is treated by wearing a night guard and working with a psychiatrist to address medication side effects and psychological factors. Therapy can be helpful if a person is extremely anxious about going to the dentist.

Oral Health and Dementia

Oral health is of particular concern for older adults. Poor oral health is common in people with dementia who may have difficulty with daily routines or engaging in more comprehensive oral care. In addition, research has associated periodontal disease and tooth loss with a higher risk for dementia. New research shows a link between gum disease and the formation of amyloid plaque associated with Alzheimer's disease. “The mouth is part of the body and if you don't take care of oral inflammation and infection, you cannot really prevent systemic diseases, like Alzheimer's,” study co-author Alpdogan Kantarci, D.D.S., MSc, Ph.D. told Science Daily.

Shappell and Cartier offer some suggestions for prevention and care for older adults.

• Individuals who are at risk for neurodegenerative disorders should seek regular comprehensive oral care, including preventive dental visits.
• People who are missing teeth should have them replaced with dental implants or dentures. Replacing missing teeth can improve nutrition and quality of life and reduce the risk for physical and mental decline.
• People with more advanced dementia can benefit from efforts to maintain oral comfort and prevent acute dental conditions.

They also emphasize the importance of collaboration among the entire health care team including dentists, physicians, social workers, mental health professionals, and others, with attention to dental health and mental health.