Suicide remains a leading cause of death globally, with over 700,000 people dying by suicide annually (World Health Organization, 2021). Research indicates that mental health disorders, particularly depression and anxiety, are critical risk factors for suicide (Nock et al., 2018). Oral health professionals, especially dentists, often encounter patients regularly for preventive and curative care, positioning them uniquely to identify early signs of mental health issues that may contribute to suicidal ideation.
The concept of oral systemic health emphasizes the interconnections between oral health and overall systemic health, including mental health. Studies have shown that oral health can reflect broader health issues, including psychological conditions (Warren et al., 2017). Given this intersection, there is an emerging recognition of the potential role dentists can play in identifying and supporting patients at risk of suicide.
The relationship between oral health and mental health is well-documented. Poor oral health is often associated with psychological distress and mental health conditions like depression and anxiety (Gibson et al., 2020). For instance, patients with mental health disorders may neglect oral hygiene due to low motivation, leading to conditions such as dental caries and periodontal disease (Johannsen et al., 2016). Conversely, chronic dental pain and tooth loss can exacerbate feelings of hopelessness and despair, potentially contributing to suicidal thoughts (Santos et al., 2022).
Additionally, certain psychotropic medications used to treat mental health disorders can lead to xerostomia (dry mouth), increasing the risk of dental decay and periodontal disease (Friedlander & Mahler, 2001). This bidirectional relationship underscores the importance of an integrated approach to health care, where dentists are aware of their patient's mental health status and collaborate with mental health professionals to provide comprehensive care.
Identifying Signs of Mental Health Issues in the Dental Setting
Dentists and dental hygienists are often among the first health professionals to notice signs that may indicate a patient is struggling with mental health issues. These signs include poor oral hygiene, signs of self-inflicted oral injuries, significant weight loss or gain affecting oral health, and a flat affect or lack of responsiveness during dental visits (Friedlander & Marder, 2002).
Moreover, dentists are well-positioned to recognize signs of anxiety and depression. Dental anxiety is a common condition that affects up to 20% of the population and can often overlap with generalized anxiety disorders (Humphris et al., 2013). By carefully observing patients’ behaviors and responses, dentists can identify individuals who may need further mental health evaluation.
The Role of Dentists in Suicide Prevention
Dentists can play a pivotal role in suicide prevention through several strategies:
Barriers and Challenges
Despite the potential role of dentists in suicide prevention, several barriers exist. These include a lack of training in mental health, time constraints during dental appointments, and concerns about patient privacy and stigma associated with mental health discussions (Walsh et al., 2013). Additionally, there may be a lack of established referral pathways to mental health services, making it challenging for dentists to connect patients with the care they need.
Dentists, as frontline health professionals, have a unique opportunity to contribute to suicide prevention efforts. By recognizing the signs of mental health issues, providing supportive environments, conducting routine screenings, and collaborating with mental health professionals, dentists can play a significant role in identifying at-risk patients and preventing suicide. Further research is needed to explore the most effective strategies for integrating mental health care into dental practice and overcoming existing barriers to implementation.
Mental health and psychological issues are covered across the AAOSH Core Curriculum. We hope you will enjoy this sample course from our core curriculum. (Please Note: This is a sample course; watching this video here does not provide CE credit. Please visit members.aaosh.org to search for these courses and earn CE credit.) Not a member? Join AAOSH today! Visit aaosh.org/about-membership to learn more about joining our organization! Use the code LEARN30 and save 30% off your membership!
Course Title: Pediatric Behavioral Issues & the Microbiome
Presented by: Dr. James G MacKenzie, DO
Original Presentation Date: 05/17/2017
Course Description:
"Pediatric Behavioral Issues & the Microbiome" explores the critical role that non-psychiatric professionals, particularly dentists, can play in addressing the growing mental health crisis among children. This course examines how dentists can implement mental health screening tools as part of their routine practice due to their unique position in healthcare and frequent interaction with families. By establishing a baseline understanding of behavioral health, dentists can collaborate effectively with medical professionals to create integrated care models that support children’s mental health and well-being. The course emphasizes the importance of multidisciplinary approaches and highlights strategies for incorporating behavioral health assessments into dental practices.
Course Objectives:
Friedlander, A. H., & Mahler, M. E. (2001). Major depressive disorder: psychopathology, medical management and dental implications. Journal of the American Dental Association, 132(5), 629-638.
Friedlander, A. H., & Marder, S. R. (2002). The psychopathology, medical management and dental implications of schizophrenia. Journal of the American Dental Association, 133(5), 603-610.
Gibson, D. S., Amarasena, N., & Kumar, S. (2020). Oral health status and hygiene habits of patients with mental disorders: A comprehensive review. Australian Dental Journal, 65(4), 292-300.
Humphris, G., Crawford, J. R., Hill, K., Gilbert, A., & Freeman, R. (2013). UK population norms for the modified dental anxiety scale with percentile calculator: Adult dental health survey 2009 results. BMC Oral Health, 13(1), 1-6.
Johannsen, A., Rydmark, I., & Söderfeldt, B. (2016). Effects of patients' anxiety, depression and behavior on oral health and treatment outcome: A patient perspective. BMC Oral Health, 16(1), 3-12.
Johnston, C., Clement, S., & Humphris, G. M. (2019). Mental health problems and dental service attendance: A systematic review. British Dental Journal, 226(9), 689-698.
Kakoulidou, T., Margaritis, V., Kakoulidis, S., & Kakoulidou, M. (2020). The dentist's role in detecting and managing mental health disorders. European Archives of Paediatric Dentistry, 21(6), 713-722.
Little, J. W., Miller, C. S., Rhodus, N. L., & Dahlen, G. (2018). Dental Management of the Medically Compromised Patient. Elsevier Health Sciences.
Nock, M. K., et al. (2018). Suicide and suicidal behavior. Epidemiologic Reviews, 40(1), 139-154.
Petersen, P. E., Kwan, S., & Ogawa, H. (2005). The role of oral health in promoting quality of life. Quality of Life Research, 14(3), 55-61.
Santos, L. F., Costa, P. S., & Ferreira, E. F. (2022). Oral health and mental health: A case-control study of Brazilian adults. Community Dentistry and Oral Epidemiology, 50*2), 106-114.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.
Walsh, L., Brooker, C., & Elston, S. (2013). Influence of psychiatric history on patients’ attitudes to dental care. BMC Oral Health, 13(1), 1-6.
Warren, K. R., & Naghavi, M. (2017). Depression and oral health: A bidirectional association. Journal of Affective Disorders, 221, 297-305.
World Health Organization. (2021). Suicide worldwide in 2019: Global health estimates. World Health Organization.