Dental Care and Mental Illness: Dental Professionals’ Perspectives and Practices

Objectives: The objective of this study was to better understand how dental providers in the Pacific Northwest view their role in providing care to the mentally ill.  Methods: Surveys were administered to dentists and dental staff at the 2011 Pacific Northwest Dental Conference (PNDC), and semistructured interviews were administered by telephone to private practice dentists. Two hundred dental professionals (76.7% female; 38.1% dentists, 34.9% hygienists, 21.1% assistants, 5.9% front office/billing/other) participated in the survey and six dentists participated in interviews (N=6; 66.6% female). Survey data were subjected to descriptive analyses, T-tests and analyses of variance to compare means between provider and practice types. Nonparametric tests examined differences in proportions of responses. The content of the interview transcripts were analyzed by extracting key concepts. Results: Significantly more dental professionals agreed or strongly agreed that patients with mental illness have poorer oral hygiene (71.0%, p<.001), are more difficult to treat (75.8%, p<.001), and are more anxious about dental treatment (79.7%, p<.001) than patients without mental illness.  Significantly more participants disagreed or strongly disagreed that mentally ill patients are easier to manage (79.7%, p<.001), and that financial compensation for treating mentally ill patients is adequate (61.8%, p<.001).  Interview responses indicated that dentists felt mentally ill patients “have more significant oral disease,” are “less able to tolerate care,” are “challenging,” have “severely neglected teeth,” and require “lengthier procedures” and “more descriptions.”  Conclusion: Though dental professionals in this sample reported significant challenges treating mentally ill patients and many factors hinder their willingness and ability to provide treatment, they continue to make special accommodations for the vulnerable mentally ill population.