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Oral Health: It's Not a Guarantee for Many

Oral health often suffers due to anxiety, depression, and dementia.

Key points

  • Many people visit the dentist after they already have substantial problems with their teeth or gums.
  • Research suggests that there is a correlation between severity of depression and dental problems, such as missing and decayed teeth.
  • Adults with cognitive impairment tend to have more cavities and other dental problems than those whose mental status is not compromised.

As my dentist was looking over my teeth a few days ago, she mentioned that she had been working at a community health clinic the previous week. She told me how upset she was by the number of patients who came to the clinic only after they were experiencing major problems with their teeth and gums, and that some of them even had growths in their mouth that might have been cancer.

“They all come in so late that sometimes it is impossible to save their teeth or prevent the spread of an oral cancer. Of course, the pandemic delayed seeking dental care," she went on to say, "but many of the patients were depressed or overwhelmed with work and family, and had neither the time, money, or for some the cognitive ability to seek oral care.”

If one has a relationship with a dental office, it is often hard to escape the gentle reminders and eventual nagging (disguised as concern) that get most of us in for a cleaning and check-up. But just as some people avoid having medical checkups unless and until a medical crisis arises, so too many avoid any dental care until usually pain drives them to seek dental intervention.

People suffering from depression have been known to neglect their oral health. In a recent study, researchers found a positive correlation between the severity of depression and dental problems, such as missing and decayed teeth, and oral dryness. Self-care may be neglected among those who are depressed so that home care of teeth and gums is not carried out regularly and dental checkups are ignored. Anxiety disorders, which may include fear of seeing a dentist, may also worsen the neglect.

Whether those with cognitive impairment might also be vulnerable to the lack of oral health care has been studied in a general population in a study in Finland. After surveying the physical and oral health status of over 2,000 adults, the authors found that adults with cognitive impairment had more caries (cavities) and other teeth and gum problems, than those whose mental status was not compromised.

These results are not surprising; one wonders how many dental offices offer the type of care necessary for someone who is depressed, anxious, or because of dementia, not certain where he or she is or what the dentist is doing. Is the dentist able to deal with the agitation or confusion of someone with serious cognitive problems? Do memory care or assisted living facilities, for example, offer regular dental checkups on site?

Interestingly, some researchers have asked whether cognitive impairment may be worsened by poor oral health, but a review of many publications looking at this question did not find a definitive answer. Patients with cognitive decline who had access to dental care had the same level of oral health as those without these issues, but there was no compelling evidence that oral infections or inflammations might increase the likelihood of dementia.

According to the American Dental Association, low-income adults are the population most vulnerable to the absence of dental care. And dental health problems may be so severe it limits the ability to work because of pain.

The inability to consume foods that are rich in nutrients and fiber may be the most pressing problem faced by those with poor dental status. An article in The Boston Globe described the concern of volunteers at a regional soup kitchen when they realized that many of those taking advantage of the free meals couldn’t eat some of the food offered because they could not chew the vegetables and fruits placed on their trays. Indeed offering smoothies made from these hard to chew foods was the solution devised by those helping in the soup kitchen, and the article described the difficulties faced by the volunteers in making the transition from chewable to drinkable foods.

Suboptimal nutrition is an obvious result of the inability to consume foods that deliver essential nutrients. Indeed lack of sufficient protein may also be added to the nutritional deficiencies caused by painful teeth (or a mouth missing most of them) because most traditional sources of protein require some chewing. Smoothies are a good solution, but one wonders how likely it is that someone without the means to get dental care will have a blender to pulverize apples and kale with yogurt, or the money to buy the expensive bottled smoothies in the food market. It may be easier to fill up on soft carbohydrates like muffins and doughnuts, because even fast foods like chicken nuggets and hamburgers may be difficult to chew.

Mobile dentistry is one solution already being used; vans are outfitted with the equipment needed to deliver dental care. They travel to elder care facilities, schools, especially in poor urban areas, and rural areas where dental offices may be inaccessible due to lack of public transportation or the ability of a patient to travel long distances. But more such vans are needed, especially at places like the soup kitchen, where the problem of obtaining dental care is so obvious.

Those of us who fret about going to the dentist for teeth cleaning or even (gasp) a root canal should consider ourselves fortunate to have access to dental care and the ability to pay for it. And we should become sensitive to the need, so often silent, of those with little or no access to such care.

Contacting one’s state dental society and asking how to help may be a start.

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