Psychiatric Illness and Dentistry: Challenges for Oral Care

Presented by: Dr. David Clark

RCDSO Expiry Date: June 30, 2024

To qualify as a Core Category 1 course, the course certificate must be issued no later than this date.

RCDSO CE Points: 3, Category 1

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  • Dr. David Clark BSc.,DDS, MSc.(Oral Pathology), FAAOP, FRCD(C)

    Dr. David Clark has worked as the Head of Dental Services at Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario, Canada from 1988- 2017 and is also an Associate in Clinical Dentistry, Department of Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Canada.

    His hospital-based practice has been devoted primarily to the general dental care of individuals undergoing primary care for various forms of psychiatric illness often co-existing with other medically compromising conditions.

    He participates in the teaching of the undergraduate dental curriculum relating to the topics of Oral Medicine and Oral Diagnosis at the Faculty of Dentistry, University of Toronto. He is a part-time clinical instructor (Dental Hygiene Program) at Durham College, Oshawa, Ontario and at George Brown College, Toronto, Ontario.

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Both psychiatric disease and dental disease are two of the most prevalent of all health problems that presently exist in our society today. In general terms, mental illness and the resulting disabilities associated with these diseases inflict immeasurable difficulties on the patients as well as their families and friends not the least of which remains the highly stigmatized nature of the disease itself. What really separates mental illness from other diseases is that it does not discriminate on the basis of age, race, economic status or gender.

As dental health care practitioners, it is incumbent upon us to improve and enhance our knowledge of this often complex yet “silent” aspect of a patient’s medical history and acquire an appreciation and understanding of our patient’s overall psychological health as it impacts and influences our ability to provide optimal oral health care.

We must be prepared to deal with the sequelae of the medical management of any particular psychiatric illness as well as the oro-facial ramifications of the illness itself. This in turn will impact on the success of our dental treatment approach and planning for many of these patients.

The current landscape of psychiatric illness reveals that one in five adult North Americans will suffer from some form of mental illness during their lifetime. A far greater percentage will not receive treatment until many years after the onset of illness. A recent W.H.O. report has now stated that depression will become the leading cause of health impairment worldwide by the year 2020.

Every oral health care practice will include patients who suffer from one form of mental illness or another, even though many of these patients will appear healthy despite dealing with their on-going emotional disorder. Mental health and oral health are intertwined and can significantly impact one another. Medications used to treat various forms of mental illness can interact with drugs used in dentistry. Oral health problems can arise as manifestations of mental illness as well as being side effects (e.g. xerostomia) of numerous psychiatric medications. Finally, psychiatric disorders often lead to decreased compliance and/or consent for preventive oral care and decreased ability to obtain or tolerate oral health treatment. The end result can be truly devastating, particularly for younger patients.

Learning Objectives:

At the conclusion of this course, participants should be able to:

  1. Demonstrate how mental health and oral health are closely intertwined and how one can directly impact the other.
  2. Comprehend how medications used to treat various forms of mental illness can interact with other drugs used in dentistry. 
  3. Understand how oral health problems can arise as manifestations of mental illness as well as being side effects of numerous psychiatric medications. 
  4. Understand the disabilities and stigma associated with mental illness as well as enhancing one’s knowledge of the various psychiatric disorders so as to be better prepared to provide dental treatment on a highly individualized basis.

Psychiatric diagnoses highlighted in this presentation will include:

  1. mood disorders (e.g.bipolar disorder)
  2. schizophrenia, 
  3. eating disorders, 
  4. anxiety disorders; panic disorder
  5. addictions
  6. dementia