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Why does patient mental health matter? Part 3: dental self-neglect as a consequence of psychiatric conditions Emma Elliott Emily Sanger David Shiers Vishal R Aggarwal Dental Update 2024 49:11, 707-709.
Honorary Research Consultant, Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester; Honorary Reader in Early Psychosis, Division of Psychology and Mental Health, University of Manchester; Honorary Senior Research Fellow, School of Medicine, Keele University, Staffordshire
This is the third article in a series looking at psychiatric presentations in dentistry. Recently, the oral health of people with severe mental illness (SMI) has gained significant media attention after the Office of the Chief Dental Officer for England published a statement on the importance of prioritizing oral health for people with SMI. Furthermore, a consensus statement has set out a 5-year plan to improve oral health in people with SMI. In Part 2 of the series, we discussed how a psychiatric disorder can manifest as an orofacial obsession in the absence of dental pathology. This article explores the physical presentation of dental self-neglect, specifically how different psychiatric conditions could be linked to emergency dental presentations. A fictionalized case-based discussion is used to explore clinical presentations of orofacial obsessions and their potential relationship to psychiatry.
CPD/Clinical Relevance: This paper emphasizes the role of the primary care dental team in recognition of psychiatric conditions, such as mood disorders, substance misuse and early psychosis.
Article
Recently, the oral health of people with severe mental illness (SMI) gained significant media attention after the Office of the Chief Dental Officer for England published a statement on the importance of prioritizing oral health for people with SMI.1 Two authors (VA and DS) have also been involved in a consensus statement2 that sets out a 5-year plan to improve oral health of people with SMI. Untreated dental caries makes up a significant global burden of oral disease, affecting 35% of the worldwide adult population.3 Unmanaged decay progresses into the pulp, resulting in pain and/or fistulas and abscesses. These urgent dental presentations are grouped together alongside ulcerations and referred to as PUFA (open pulp, ulcers, fistulas and abscesses). Positive PUFA symptoms are seen in 7% of the UK population4 and are related to socio-economic status, poor general health and length of time since last dental visit. Unmanaged psychiatric conditions can be a determinant for poor oral health owing to reduced self-care, reduced access to routine dental care and associations with substance misuse.5 In this article, we consider substance misuse and mood disorders, and how they can relate to a presenting complaint of PUFA alongside rampant decay.
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