People with severe mental health problems often face multiple challenges, but one that is often overlooked but critical is that their oral health is significantly worse than the general population.
Research has found that people with severe mental illnesses such as major depression, bipolar disorder or schizophrenia are four times more likely to develop gum disease and are almost three times more likely to lose all their teeth.
About 800,000 Australians are affected by these conditions, and people with schizophrenia have an average of eight more decayed, missing or filled teeth than the general population.
Why are oral problems so serious?
The high cost of dental treatment, coupled with the fact that dental problems can seriously affect eating, socializing, employment and even simply smiling, make poor oral health a major factor affecting quality of life.
Not only that, our research also shows that dental problems are the third leading cause of preventable hospitalization for people with severe mental illness.
Even more worryingly, the bacteria in gum disease can trigger systemic inflammation, which can lead to chronic diseases such as diabetes, heart disease, some cancers and cognitive decline.
The complex relationship between mental health and oral health
The relationship between the two is bidirectional. Factors such as social isolation, unemployment and housing instability not only undermine mental health, but also hinder people from maintaining good oral hygiene habits. Losing a job can mean less income, which in turn affects access to dental care services and the quality of diet.
At the same time, dental problems can exacerbate psychological distress. For example, missing teeth or tooth decay can affect a person’s appearance, leading to low self-esteem and social avoidance.
Mental health problems themselves can also make people less motivated to take care of themselves, such as brushing and flossing regularly or making dental appointments.
Some people with mental illness say they are afraid of going to the dentist, sometimes because of past traumatic experiences. In addition, medications used to treat mental illness can sometimes cause dry mouth and increase sugar intake, further increasing the risk of tooth decay.
How do people view this issue?
In our recent interviews with young people with mental illness, they confessed that oral health problems bring not only physical pain, but also psychological and social burdens.
One respondent said:
“It’s not just about eating, it’s about my self-esteem, confidence, and even basic mental health, and it’s made me more isolated.”
Another added:
“I’m scared to go to the dentist because I don’t know how to explain it – I’ve been going through a really bad depression, and I know I’ve been ignoring a lot of things, but I didn’t mean to.”
What can we do about it?
To address this, we designed and tested an online oral health education program for young people with mental health problems. Results showed that the program significantly improved participants’ oral health knowledge and positive attitudes.
However, improving oral health in this group is not easy. Due to limited coverage of dental care in the public health system, many patients only seek medical attention when their symptoms become severe, often requiring invasive treatments such as tooth extraction.
A more holistic and coordinated health care system is urgently needed. Mental health workers should receive oral health knowledge training, and dentists should understand the special needs of people with mental illness.
In addition, the government should increase investment, strengthen the oral health service system, promote interdisciplinary cooperation, and more effectively integrate mental health, oral health, and community support networks.