Understanding Mental Health

• Mental health is a state of mind supported by protective factors and challenged by risk factors.
• Mental health includes emotional, psychological, and social well-being.
• Mental health is more than the absence of mental illness.
• Factors like genetics, life circumstances, and stressors influence mental health.
• Positive mental health includes confidence, feeling in control, resilience, and good relationships.
• Mental illness affects thinking, feeling, behavior, and duration.
• Mental illness can cause distortions in thoughts, perception, and reasoning.
• Mental illness can cause mood fluctuations and difficulties in managing feelings.
• Changes in actions, habits, and daily functioning can happen due to mental illness.
• Mental Illness duration can be occasional or chronic.
• Biological factors like genetics and brain chemistry can cause mental health disorders.
• Psychological influences, such as trauma and stress management abilities, impact mental health.
• Environmental triggers, including life stressors and adversity, play critical roles in mental health disorders.
• Social determinants like social support networks and socioeconomic status affect mental wellbeing.
• Infections can cause mental health disorders like Syphilis.
• 1 in 5 Americans has a mental illness.
• Anxiety disorders are the most commonly reported mental health issue, affecting 42.5 million Americans.
• Symptoms of mental illness may start by age 14.
• About 1 in 4 American adults has a diagnosable mental disorder each year.
• About 1 in 10 may have a depressive illness like major depression or bipolar disorder.
• Mental health crises account for 60 million primary care visits and 6 million ER visits annually.
• 41% of Americans deal with an untreated mental illness.
• 10.7% of the world suffers from some form of mental illness.
• About 40 million Americans suffer from anxiety.
• 20% of adults had a mental illness in 2024.
• 77% of adults identify finances as a significant stressor.
• 50% of all mental illness starts before age 14, with 75% starting before age 24.
• 46% of Americans will meet the criteria for a diagnosable mental health condition.

The connection between Mental Health and Whole Health

• Heart disease, diabetes, and mental illness are related.
• Depression increases cardiac events and complicates recovery.
• Anxiety disorders lead to a higher stroke incidence.
• Chronic stress impairs immune response and healing.
• Mental health affects cancer treatment adherence and recovery outcomes.
• Understanding providers who acknowledge challenges improve willingness to seek and continue dental care.
• Recognize the individual beyond their diagnosis or condition in a "person-first" approach.
• Use "person with schizophrenia" rather than "schizophrenic" to practice respectful language.
• Acknowledge capabilities alongside challenges.
• Include patients in treatment planning regardless of mental health status.
• Skill development reduces patient anxiety.
• Medication awareness prevents negative drug interactions.
• Providing mental health resources becomes part of comprehensive care.
• Education helps reduce stigma and improve outcomes.
• Common Mental Health Disorders: anxiety disorders (18.1%), mood disorders like depression (6.9%) and bipolar disorder (2.6%), eating disorders (10-15%), and substance use disorders.
• Generalized Anxiety is persistent worry about everyday concerns, affecting daily functioning.
• Obsessive-Compulsive disorder involves recurring thoughts driving repetitive behaviors to reduce distress.
• Panic Disorder causes sudden episodes of intense fear with physical symptoms like racing heart.
• Post-Traumatic Stress causes lingering psychological effects after experiencing traumatic events.

Symptoms of a panic attack

• Shortness of breath
• Dizziness, unsteady feelings, or faintness
• Palpitations or accelerated heart rate
• Trembling or shaking
• Sweating (clammy hands)
• Choking
• Nausea or abdominal stress
• Paresthesia (numbness or tingling sensation)
• Flushes (hot flashes) or chills
• Chest pain or discomfort
• Fear of dying
• Fear of losing control
• Xerostomia and excessive brushing often manifest in anxious patients, leading to tissue damage.
• Consider motivation, memory issues, and medication effects when creating care plans for anxiety treatment.
• Morning appointments, step-by-step explanations, and positive reinforcement significantly reduce anxiety.
• Major Depression features persistent feelings of sadness and loss of interest affecting daily functioning.
• Postpartum Depression affects both mothers and fathers after childbirth, impacting parent-child bonding.
• Treatment Approaches for depression typically combine pharmacotherapy, psychotherapy, and sometimes electroconvulsive therapy for severe cases.
• Mood Extremes are cycles between depressive episodes and manic periods with elevated energy and mood in Bipolar disorder.
• During manic phases of Bipolar disorder, patients may make impulsive decisions affecting health choices.
• Treatment typically requires mood stabilizers like lithium plus psychotherapy for optimal management.
• Medication side effects often include xerostomia and increased caries risk.
• Dental Hygiene Care for mood disorders includes shorter, morning appointments when energy levels are higher.
• Monitor for xerostomia and recommend appropriate saliva substitutes.
• Provide simplified home care instructions with visual aids.
• Maintain consistent follow-up to address emerging issues promptly.
• Disorganized thinking and speech patterns affect communication in Schizophrenia.
• Hallucinations and delusions can affect perception of reality and trust in Schizophrenia.
• Antipsychotic medications and psychosocial therapy form the foundation of care for Schizophrenia.
• Use clear, concise instructions with frequent check-ins for understanding.
• Minimize distractions and maintain a calm, predictable setting for Schizophrenia patients.
• Monitor for severe xerostomia, tardive dyskinesia, and bruxism.
• Work with mental health providers to optimize treatment timing.
• Anorexia Nervosa involved severe restriction of food intake leading to significantly low body weight.
• Bulimia Nervosa involves cycles of binge eating followed by compensatory behaviors like purging.
• Binge-Eating involved large amounts of food with loss of control during episodes.
• Pica is persistent eating of non-nutritive substances like clay or paper.
• Orthorexia Nervosa is an unhealthy obsession with healthy eating.
• Nutrient Deficiencies lead to decreased salivary flow and compromised immune response in Anorexia Nervosa.
• Mucosal Atrophy features thin, pale oral tissues with increased susceptibility to trauma in Anorexia Nervosa.
• Delayed Healing is when poor nutritional status impairs tissue repair after procedures.
• Osteoporosis from Anorexia Nervosa affects jawbone density and periodontal health.
• Perimylolysis is a characteristic erosion pattern on lingual surfaces of maxillary anterior teeth due to Bulimia Nervosa.
• Dentin Sensitivity is when exposed dentin leads to significant temperature and tactile sensitivity in Bulimia Nervosa.
• Sialadenosis is a painless enlargement of salivary glands, particularly the parotids.
• Perimylolysis, dental caries, mucosal lesions, xerostomia, hypersensitive teeth, and bruxism are oral hygiene considerations for feeding and eating disorders.
• Clinical manifestations vary by eating disorder type.
• Anorexia shows tissue atrophy and delayed healing.
• Bulimia presents characteristic erosion patterns.
• PICA may involve unusual abrasion patterns from non-food substances.
• Advise against brushing immediately after vomiting to prevent erosion and take protective measures.
• Emphasize a connection between nutrition and oral health.
• Suggest rinsing with water or neutral solutions like baking soda.
• Recommend high-concentration fluoride products for remineralization.
• Encourage sugar-free gum and adequate hydration to neutralize options.

Common Psychiatric Medications

• Antidepressants, such as Fluoxetine and Sertraline can cause Xerostomia and bruxism.
• Antipsychotics, such as Risperidone and Olanzapine can cause severe dry mouth and dyskinesia.
• Anxiolytics, such as Diazepam and Lorazepam, result in increased infection risk.
• Mood Stabilizers like Lithium and Valproate, can cause stomatitis and dysgeusia.

Considerations when treating psychiatric patients

• Verify potential drug interactions before prescribing or recommending medications.
• Understand oral manifestations of psychiatric medications to anticipate issues.
• Confirm appropriate dosing, especially for anxiolytics used during dental treatment.
• Identify precautions for specific mental health conditions or medications.
• Gather complete medical history including all medications and mental health conditions.
• Consult with patients' mental health providers to coordinate treatment approaches.
• Recognize biological, psychological, and social components of psychiatric disorders.
• Identify patients who require modified approaches to ensure comfort and safety.

Medical History Interviewing

• Ask open-ended questions
• What condition is this medication treating (many medications treat multiple conditions)
• What are your symptoms?
• How long have you been taking this?
• Does it help?
• Who is the physician treating you for this?
• How often do you see him/her?
• Last hospital visit?(CMI)
• How can I help?
• Speak slowly

Making a Difference

• Every interaction improves mental health outcomes.
• Open conversations normalize mental health care
• Welcoming environment encourages regular dental visits
• Consistent, compassionate care creates lasting relationships
• Schedule shorter, morning appointments for patients with anxiety or depression.
• Use simple, direct language and provide written instructions.
• Offer breaks, noise-canceling headphones, or weighted blankets.
• Record successful approaches for future appointments.
• Psychiatric disorders are prevalent.
• Psychiatric disorders are under-recognized and under-diagnosed.
• Psychiatric disorders are frequently misunderstood.
• Psychiatric disorders are associated with high rates of medical co-morbidity and increased dental problems
• Psychiatric disorders are associated with reduced rates of compliance with dental and medical treatments.
• Psychiatric illness may present with physical symptoms (e.g., pain).
• Psychiatric disorders are associated with higher rates of substance use disorders.
• Psychotropic medications may have short- and long-term adverse effects.
• Psychotropic medications may interact with drugs used in dentistry and with other medications patients are taking.
• Mental illness can be treated, those with mental illness can get better and many recover completely.