A Summary of: Lloyd-Williams F, Dowrick C, Hillon D, Humphris G, Moulding G, Ireland R. A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems. Br Dent J. 2001 Dec 8;191(11):625-9. doi: 10.1038/sj.bdj.4801252. PMID: 11770949.
By Sathyam Sharma, Barts BDS5
Background:
Mental health conditions are becoming more prevalent in the general population, with such conditions also known to have effects on a patient’s oral health; the self-neglect, increased sugar intake, substance abuse and irregular dental attendance associated with many different mental disorders can cause many dental issues.
Therefore, whilst it is apparent these patients must be presenting themselves to dental clinics, their exact prevalence is unspecified, the GDP’s ability to recognise such patients is unknown, and there appears to be a general lack of training and confidence when it then comes to the GDP attempting to assist such patients.
Study:
Hence, the three main aims of this study were:
1. What extent do GDPs encounter dental patients with mental health problems?
2. What procedures do GDPs follow with such patients?
3. Do GDPs regard themselves as having a role in identifying such patients?
To answer these questions 74 GDPs from the Mersey region were questioned, 54 via telephone interviews and the remaining 30 via semi-structured postal questionnaires.
Results:
The results showed that GDPs do encounter dental patients experiencing mental health conditions. These range from typical depression and dental anxiety/fear to severe diagnosable mental illness. More specifically, 57% of respondents reported seeing patients present with dental symptoms they suspected were solely psychosomatic and caused by related mental conditions. Of those GDPs who stated they were unaware of encountering any patients with mental health conditions, their comments indicated they do not actively pay attention or necessarily recognise the signs and symptoms of these conditions, and conceded this may be due to a lack of knowledge/skills on their part.
In terms of how such patients are addressed by GDPs, 46% of respondents did not make any sort of referral to a GMP or dental specialist, and those that did tended to make said referrals based on the patient’s physical manifestations as opposed to the underlying psychological issues. Of those GDPs who did not make any referrals, some did suggest they allocate extra time when treating the patient instead – presumably to facilitate further conversation. However, unfortunately overall this suggests that the true aetiology of patients’ problems may not always be best addressed, if at all.
When discussing who they would like to refer patients to, 70% of those interviewed stated they felt the GMP was best for an initial referral. However these respondents also noted there exists a distinct lack of communication between themselves and GMPs; GDPs also feel that GMPs view them being only interested in patients’ oral health, and that GMPs may therefore be sceptical of accepting them in this role.
Furthermore, 50% of respondents were concerned how patients might react if the GDP were to address such a topic to them; it was thought that the stigma surrounding mental health conditions may cause reluctance regarding e.g. a referral.
Discussion and Recommendations:
This study overall suggests that firstly, GDPs are aware of encountering patients with mental health problems, including those with dental conditions of related psychosomatic origin, and secondly, that most GDPs are willing to help these patients, however their knowledge, skills and confidence when addressing and referring these patients are currently inadequate.
This study therefore recommends further research centring around improving methods of information exchange between GDPs and GMPs, and the creation of guidelines to help GDPs be aware of relevant symptoms and appropriate referral pathways, hoping to ultimately give referring GDPs confidence in efficiently and appropriately managing these patients.
Sathyam Sharma BDS5