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CLINICAL Hygiene Tribune U.S. Edition | April 2013E2 Individuals affected by SMI often do not seek oral health care services, exac- erbating existing disease and leading to new oral-health problems. The dys- function in such patients’ lives caused by the symptoms of the illness, finan- cial distress, lack of family support and possible hospitalizations or incarcera- tion can interfere with any opportunity to secure consistent dental care. When theses patients are finally able to see a dental health professional they might be extremely self-conscious about the dete- rioration of their mouth and concerned about facing disapproval — and fearful of that treatment might be painful. Depending upon the severity and symptoms of the patient’s mental ill- ness, the patient’s beliefs about teeth might be altered — and fall outside the realm of standard beliefs. For example, a client with paranoid schizophrenia may be so concerned about the microbes in his or her mouth that he or she brushes excessively, causing damage to teeth and supporting structures. Another patient with an SMI might believe that dental plaque is natural and should remain on his or her teeth. Delusional beliefs may interfere with compliance. Handle altered perceptions When treating a client with an SMI, den- tal hygienists need to be aware that hal- lucinations can cause apparent changes in a patient’s perception of touch, taste, sound, sight and smell — with increased or decreased sensitivity. Topical anesthetics or dentinal anti- sensitivity medicaments may need to be applied for comfort prior to scaling. And special care is required when polishing with the prophy angle, because the vi- brations generated may be interpreted as painful or extremely annoying. Using a soft toothbrush may be a better option. The taste of the polish offered should be appealing, otherwise consider substitut- ing polish with fluoridated toothpaste. For keeping the patient calm, the use of audio to muffle dental sounds can be helpful. It also can help to quickly dis- card gauze splattered with blood and debris and if possible keep dental instru- ments out of sight. Although electric toothbrushes may be ideal for home-care use, some clients may have a low tolerance for the vibra- tions. Therefore, a manual toothbrush with a comfortable handle and grip may be a better choice. Sometimes relying on a Waterpik, oral rinses, home fluorides, remineralization pastes, probiotic loz- enges, xylitol gum and mints may be the only real home care some members of this population will follow because of comfort, taste, smell and/or energy level. People with an SMI might be extremely self-conscious and easily able to sense if their caregivers are comfortable admin- istering treatment. It can be very im- portant that when administering dental treatment to these clients that consistent eye contact is maintained and genuine interest is shown for their comments or concerns. Be organized, upbeat, caring Dental professionals should strive to have a keen understanding of these pa- tients’ unique fears and follow a system- atic approach in a well-organized, up- beat, and caring manner. After evaluating the oral health needs — and understanding the impact of the illness itself on the patient’s thought pro- cess and behaviors — the dental hygien- ist can offer creative and thoughtful sug- gestions to motivate these dental clients. Dental hygienists have a unique oppor- tunity to offer not just oral care but to give these clients a safe and secure place to feel “cared for.” ◊ UNDERSERVED, page E1 3 severe mental illnesses dominate Schizophrenia Schizophrenia is a chronic, severe and disabling brain disease characterized by a disintegration of the process of think- ing, emotional responsiveness and con- tact with reality and consists of a group of symptoms that show wide variations in disordered thinking, feelings and be- havior. One percent of the U.S. population is affected, primarily between the ages of 17 to 24 in males and 28 to 35 in females. The illness is universal in symptoms across all cultures. It is considered an epigenetic/genetic illness, which means if one carries the phenotype, certain en- vironmental forces over time can cause the expression of those genes. These environmental forces can include: so- cial stress, drug abuse, head trauma, infections and outside factors that can contribute to dysfunctional brain de- velopment. Each case is unique and depending upon severity of the symp- toms, lifelong treatment can include: medication, hospitalization, psycho- therapy, cognitive therapy, job coaching and alternative housing. (Source: National Institute of Mental Health) Bipolar disorder Bipolar disorder is a medical illness that causes extreme shifts in mood, energy and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. More than 10 million people in the United States have bipolar disorder, and the illness affects men and women equally. Bipolar disorder is a chronic and generally lifelong condition with recur- ring episodes of mania and depression that can last from days to months that often begin in adolescence or early adult- hood — and occasionally present even in children. While medication is one key el- ement in successful treatment of bipolar disorder, psychotherapy, family support and education about the illness are also essential components of the treatment process. (Source: National Alliance on Mental Health Major depression Major depression is a serious medical illness affecting 15 million American adults, or approximately 5 to 8 percent of the adult population in a given year. Unlike normal emotional experi- ences of sadness, loss or passing mood states, major depression is persistent and can significantly interfere with an individual's thoughts, behavior, mood, activity and physical health. Among all medical illnesses, major depression is the leading cause of dis- ability in the United States as well as in a number of other developed coun- tries. (Source: National Alliance on Mental Health) Most frequently diagnosed, most likely to be encountered by dental professionals Depending on severity of the mental illness, a patient’s beliefs about teeth might be altered — and fall outside the realm of standard beliefs. Illustration/Provided by www.dreamstime.com HYGIENE TRIBUNE Tell us what you think! Do you have general comments or criticism you would like to share? Is there a particular topic you would like to see articles about in Hygiene Tribune? Let us know by e-mailing feedback@dental-tribune.com. We look forward to hearing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental-tribune.com and be sure to include which publication you are referring to. 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If you find a factual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@dental-tribune.com. Tribune America cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume respon- sibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Tribune America. editOrial bOard Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criticism you would like to share? Is there a particular topic you would like to see articles about in Hygiene Tribune? Let us know by e-mailing feedback@dental-tribune.com. We look forward to hearing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental- tribune.com and be sure to include which publication you are referring to. Also, please note that subscription changes can take up to six weeks to process.