The Right to Smile: the latest research on psychosis and oral health | News and Events

The Right to Smile: the latest research on psychosis and oral health

By David Shiers, Elizabeth Turner & Kyriakos Velemis

It is well known that people with severe mental ill health often have their lives restricted and shortened by conditions like diabetes and heart disease. [1] Less attention has been paid to inequalities in oral health. Yet, compared with the general population, research [2] has shown people with a diagnosed with a serious mental illness:

  • are three times more likely to lose all their teeth
  • have on average five more decayed teeth
  • are two times more likely to have late detection of oral cancer

Moreover, poor oral health can lead to high levels of pain and discomfort and can impact on self-esteem and quality of life, affecting activities as basic as eating and talking, and interfering with a person’s relationships and their ability to keep a job. [3]  We also know that mental health difficulties can lead to lower motivation, feelings of anxiety, and a reluctance to seek dental help. [4]  A recent systematic review [5] led by Dr Liz Turner, GMMH, found that people with diagnosed with a serious mental illness were less likely to attend routine dental appointments and brush their teeth compared to the general population.

Building on this research, our recent study [6] found that people with a history of psychosis are more likely to have gum disease (signalled by bleeding and painful gums, and loose teeth) than the general population. It is known that gum disease is linked to factors such as smoking and poor diet, and our study confirmed these health risk behaviours further increased the risk of gum disease in those with psychosis. We also found the risk of gum disease in this group was linked to certain demographic factors (being older, female, and of non-white ethnicity) and the presence of co-existing physical diseases (heart disease, respiratory disease and cancer).

Gum disease is important. Once established, it can progress to tooth loss, and may also harmfully interact with systemic diseases like diabetes and heart disease through a process of chronic inflammation.

In response to increasingly robust evidence, we recently launched The Right to Smile campaign which believes that tackling this health inequality is overdue and deserves urgent attention in three key areas:

  • No physical check is complete without a consideration of oral health
  • Equality of access to routine dental checks is practically supported (Equalities Act 2010)
  • Importance of good oral health is reflected in ALL training and policy about meeting the physical health needs of people with severe mental ill health

Fundamentally The Right to Smile is about rights: poor oral health should not be the inevitable consequence of experiencing severe mental ill health.

Picking up on dental access as a key area of The Right to Smile, at GMMH we have started recruiting for our Mouth Matters in Mental Health study. This study will test whether support workers can help people treated by secondary care mental health services access dental services. It’s recruiting service users from community mental health teams and early intervention services who have not seen a dentist in the past three years. The support worker will help service users find an NHS dentist, apply for free or subsidised dental care, and book or attend dental appointments.  

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[2] Choi J, Price J, Ryder S, Siskind D, Solmi M, Kisely S. 2021. Prevalence of dental disorders among people with mental illness: An umbrella review. Aust N Z J Psychiatry. 48674211042239

[3] Patel R, Gamboa A. 2012. Prevalence of oral diseases and oral-health-related quality of life in people with severe mental illness undertaking community-based psychiatric care. Br Dent J. 213(9):E16.

[4] lack-Smith L, Hearn L, Scrine C, Durey A. Barriers and enablers for oral health care for people affected by mental health disorders. Aust Dent J. 2017;62(1):6-13.

[5] Turner E, Berry K, Aggarwal VR, Quinlivan L, Villanueva T, Palmier-Claus J. Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand. 2022;145:29-41. doi: 10.1111/acps.13308)

[6] Kang, J., Palmier-Claus, J.E., Wu, J., Shiers, D., Levin, H., Doran, T. & Aggarwal, V.  Periodontal disease in people with a history of psychosis: Results from the UK Biobank Population-based Study.  Community Dentistry and Oral Epidemiology 2022

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