Navigating the Boundaries Between Oral Health and Mental Health
As dentistry focuses more on treating the patient and not just the mouth, clinicians must balance recognizing the links between oral and systemic health with practicing within their professional competence.
The relationship between oral health and overall well-being has never been more apparent and a paradigm shift has occurred in dentistry in which the emphasis has moved away from just treating the mouth to treating the whole person. Increasingly, oral health professionals encounter patients whose oral conditions may be influenced by psychological, behavioral, or systemic factors. While these conversations can uncover important contributors to oral disease, they also raise an important question: Where does the oral health professional’s responsibility end and another healthcare provider’s begin?
Often discussions about poor oral hygiene include patients’ cigarette use, alcohol consumption, and poor eating habits, which may move the focus to emotional, mental, and psychological issues. Some patients believe these to be personal matters and don’t appreciate the connections between dental health, mental health, and general health.
The environment can become uncomfortable quickly with patients reluctant to continue discussing matters they perceive as unrelated to oral health. On the other hand, when patients do engage in a meaningful way, the appointment becomes significantly more time-consuming than simple conversations about the teeth, gums, and the mouth. As oral health professionals, we are expected to work within our professional training and competence. My formal training was largely limited to the teeth, gums, and mouth. I suspect that if a patient ever complained about intrusive questioning, I would struggle to prove my competence in psychological, psychiatric, or even general medical matters.
This is why, as primary care providers, we are required to identify potential causes and make appropriate referrals to discipline-specific providers. One obstacle is that we may not be familiar with the expertise of other healthcare providers and thus struggle to make appropriate referrals. Additionally, professionals from other disciplines may be unaware of the links between their speciality and oral health.1
The holy grail is getting the balance right. My preference is a shared dialogue based on patients’ level of engagement. I make clear entries in the clinical record about what patients have instructed me to avoid discussing. In addition to this, I strongly recommend patients see their medical doctor. I also advise patients that their physician may make further referrals. In most cases, I then apologize for other healthcare professionals’ lack of awareness regarding the oral-systemic link.
The shift from treating the mouth to treating the patient is a positive one; however, we need a unified guidelines on who should be responsible for each element of a patient’s care.
Reference
- Bissett SM, Stone KM, Rapley T, Preshaw PM. An exploratory qualitative interview study about collaboration between medicine and dentistry in relation to diabetes management. BMJ Open. 2013;3:e002192.
