Why does patient mental health matter? Part 1: The scope of psychiatry within dentistry

Psychiatry is the branch of medicine that deals with mental disorders and their treatment. As healthcare professionals, dental practitioners will inevitably encounter patients with mental health problems, ranging from those with established diagnoses of mental illness who are stable in their mental state, to those with new or acute psychiatric symptoms. These presentations may be associated with dental symptoms and pathology, or may be completely independent thereof. The General Dental Council states that dental graduates should be able to ‘identify, explain and manage the impact of medical and psychological conditions as part of patient management’.¹ In practice, this means dentists need to recognize and respond to mental health problems by liaising with general medical, psychiatric or emergency services as appropriate.

Some general dental practitioners (GDPs) feel limited in their knowledge and skills in the identification and management of such patients. One survey identified that only 9% of GDPs referred dental patients with possible mental health problems to their general medical practitioner (GMP).² This might be due to constraints of knowledge or confidence: infrequent referrals were associated with poor awareness of how to broach the subject with the patient and where to refer them.² Barriers to addressing psychiatric problems in the dental setting appear to be rooted in practitioners lacking confidence about their assessment, or concerns that asking about mental health problems could negatively affect the patient–dentist relationship.^3,4 Indeed, one study suggested that dentists feared their patients might deny the condition or be insulted by a discussion of mental health.⁴