Last year I met a patient whom we will call Stacy. Stacy had only four lower front teeth with all other lower teeth and all upper teeth decayed and broken down. Her goal was to have dentures so that she could gain employment– she had been rejected for several job opportunities and felt this was related to her appearance. She had about $1,200 to put toward her treatment, however, her estimated cost of care was over $6,000. Fortunately, I work at a University and we were able to re-direct her to the student clinics where she received her care for $1,200.
Research has shown that the number of decayed and missing teeth actually can predict depression in certain populations. That’s because, the investigators suggested, oral health is related to quality of life. A different study found that oral health of a child with special needs actually predicts whether their mother will have depression or not. What this study found is that there is an association between the number of decayed and missing teeth of the child and the mom’s risk of depression – this has incredibly powerful implications for dentists as healthcare providers.
While there is significant awareness of the fact that oral health affects general health there is less knowledge about the how it affects mental health. Depression is a common, complex, and multifactorial disease and treating oral health is only a small part of any solution. However, imagine the scenario of someone who has visibly poor oral health – research shows that poor oral health is a risk factor for unemployment! Not having a job will hinder their ability to purchase high quality healthy food, access healthcare and undermine their ability to gain a better education. All of these factors are known to be associated with poorer health and wellbeing.
In 2014 we published a study that found 12,080 patients hospitalized in US hospitals (during the 4 years of the study) for an oral health condition had a concurrent mental health condition. The mean length of stay was 3 days and the hospital charges were over $1 billion which has significant implications for federal and state expenditures. Moreover, when these patients first presented to the ER their hospital charges were much more than when patients without mental health conditions presented to the ER with the same dental condition. Dental health and mental health are closely related and dentists and mental health professionals should bear this in mind as they render care. We must all be careful not to treat in silos conditions that are inter-related and multifactorial in nature.