How Does Oral Health Affect Mental Health?

Even before the COVID-19 pandemic hit the United States in 2020, patients with mental health disorders were more likely to have more dental problems than the general population. The pandemic exacerbated these issues, as subsequent COVID-19 restrictions resulted in job losses, increased stress, and isolation. In addition, dental clinic closures limited patients’ access to care.

To further examine the relationship between oral health and mental health, the CareQuest Institute for Oral Health conducted a nationally representative study in January and February 2021 that asked more than 5,300 adults ages 18 and older to self-rate their mental health and oral health status, and oral healthcare utilization. The report, “State of Oral Health Equity in America 2021,” found almost one out of five respondents rated their current mental health status as fair (14%) or poor (4%), suggesting poor mental health status may be linked to delayed oral healthcare. 

Those who identified as having poor mental health reported higher rates of unmet oral healthcare needs across all categories, with the top unmet oral health needs being toothache (34%), swollen or bleeding gums (30%), pain when chewing or swallowing (25%), and frequent xerostomia (25%). 

“This research further supports the need for a more integrated system of care in which patients’ oral health, mental health, and overall health are treated holistically to improve health outcomes and make our system more efficient,” says Julie Hawley, RDH, PhD, CAE, director of analytics and evaluation for the CareQuest Institute for Oral Health. 

According to a Kaiser Family Foundation analysis1 of the Household Pulse Survey, a large percentage (56%) of young adults ages 18 to 24 reported symptoms of anxiety and/or depressive disorder during the pandemic. Social isolation and stress affected the mental health of older adults ages 50 to 80,2 with nearly one in five older adults saying their mental health has worsened since the pandemic, and more than one in four reporting being more anxious. 

Dentists and dental hygienists should be prepared with anxiety management tactics to help put these patients at ease, as 47% of those with poor mental health said their last dental visit “went well, but they were nervous,” compared with 27% of respondents with positive mental health status. Additionally, respondents with poor mental health said they were more likely to say they were “so frightened and nervous that it made treatment difficult.” 

Oral health professionals should also be prepared to screen patients for mental health conditions, such as major depressive disorder or anxiety disorders. Understanding treatment modalities and proper preparation can help clinicians provide a positive and effective dental health experience for these individuals. Education is also important, as patients are not often aware of the mouth-body connection. 

“All healthcare providers, not just oral health providers, can arm their patients with this knowledge and empower them in their own healthcare routines,” says Hawley. “Oral healthcare providers can also be agents of policy change and lend their voice to the need for a more integrated healthcare system.”

Integration of primary care, oral health, and mental health services improve access to care for patients since all healthcare providers are available in one location. It also results in more patient-centered care. 

Additionally, adding a Medicare dental and expanding Medicaid programs to include an adult dental benefit is also needed to help close these gaps in care and accessibility.

“We must fundamentally address disparities in access to care. More than 65 million Americans lack dental coverage, and one of the primary reasons is that our nation’s Medicare and Medicaid programs do not include adult dental coverage or do so inconsistently from state to state,” says Hawley. This creates a barrier for our aging population and historically marginalized communities who rely on Medicare and Medicaid for healthcare.” 

According to the survey, compared to other racial/ethnic groups, Black respondents with poor mental health were prescribed the greatest number of opioids after oral surgery (18%). Americans with poor mental health were prescribed opioids following oral surgery at a higher rate than patients with good mental health. Those with poor mental health and lower income (less than $30,000/year) were more than twice as likely to be prescribed opioids after oral surgery (12%) than those with poor mental health in the highest income group ($100,000/year). 

Hawley adds, “Oral health is too often treated separately from overall health. We see it in the way our dental practices are siloed from our medical practices and in the way our Medicare program and some Medicaid programs do not cover oral health benefits for adults. This lack of integration creates disparities in access, which leaves some of our most underserved populations behind.” 

REFERENCES

1. Kaiser Family Foundation. The Implications of COVID-19 for Mental Health and Substance Use. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/. Accessed June 18, 2021. 
2. University of Michigan Health Blog. Pandemic Worsened Many Older Adults’ Mental Health and Sleep, Poll Finds, But Long-Term Resilience Also Seen. Available at: https://healthblog.uofmhealth.org/health-management/pandemic-worsened-many-older-adults-mental-health-and-sleep-poll-finds-but-long. Accessed June 18, 2021.