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Why does patient mental health matter? part 5: chronic orofacial pain as a consequence of psychiatric disorders Vishal R Aggarwal Emily Sanger David Shiers Jenny Girdler Emma Elliott Dental Update 2024 50:2, 707-709.
Authors
Vishal RAggarwal
BDS, MFDSRCS, MPH, PhD, FCGDent,
Clinical Associate Professor in Acute Dental Care and Chronic Pain; School of Dentistry, University of Leeds
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 final 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 4, we discussed how a psychiatric disorder can result in dental pathology by contributing to risk factors associated with tooth surface loss. This article explores chronic orofacial pain symptoms and their link with psychiatry, considering the role of the primary dental care team in early recognition of psychiatric disorders. Given the range of chronic orofacial pain subtypes, we will present two separate fictionalized case-based discussions to explore their presentation.
CPD/Clinical Relevance: The primary care dental team has a role in recognition of psychiatric conditions and subsequent chronic orofacial pain.
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.
One in five presentations to primary care involve medically unexplained symptoms (MUS) or persistent physical pain.3 Of those affected, half live with anxiety or depression, positioning these conditions as either a consequence of the persistent pain or as part of the aetiology. There is a strong relationship between anxiety, depression, somatic symptom disorders and substantial social or physical impairment.4
Somatic symptoms are physical symptoms that arise due to emotional or psychological factors. Anyone experiencing anxiety, depression or distress can somatize physical symptoms, but there are also specific somatization disorders (eg bodily distress disorder) marked by the presence of MUS.4 Research has indicated that somatization disorders may have a prevalence of between 16.1% and 21.9% in general practice. This poses challenges for those in primary care when physical symptoms (including chronic primary pain) present without underlying organic pathology and are instead related to psychosocial factors.5
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