The article points out that effective oral assessment is one the key recommendations of the Government’s ‘Five Year Forward View for Mental Health’ “for addressing the stark inequalities in oral health outcomes for people living with serious mental health problems”. It goes on to note that “people who use mental health services are more likely to experience significant tooth loss and decay than the wider population”. In addition, there are specific patients with “long term mental illness, who are at greater risk of dental problems – for example, as a result of medications or lifestyle factors such as smoking.”
However, in spite of this clear need, the piece states that “many mental health nurses do not carry out oral assessment”. In addition, many nurses experience obstacles when undertaking effective oral health assessments and oral health promotion for mental health patients in inpatient settings. Some of the difficulties nurses may experience included a lack of knowledge, including the side effects of certain medications on oral health. Although generic oral health assessment tools are widely available, these are not used as often as they could be, with many nurses relying on subjective assessments.
The author concludes that a flexible assessment tool could be developed to help guide nurses through key screening factors in oral health amongst the inpatient mental health population, including information on the effects of medication and lifestyle factors. This tool could include preventative and risk reduction measures, as well as identifying and documenting poor oral health for treatment. The article also suggests both pre- and post-registration nursing training could be an effective way to help bridge the gap between theory and practice. Finally, the article recommends that additional research be undertaken to understand why many mental health nurses do not carry out oral assessments for patients.
Ashley Morgan commented, “I developed a strong interest in the oral health of patients in inpatient mental health settings during my time as a student mental health nurse. I feel this is an undervalued area of health, and, if mental health nurses could be better supported to carry out assessments and promote good oral health, it would have a big impact on patients.”
Professor Jenny Gallagher MBE, head of division for Population and Patient Health at King’s Dental Institute, added, “It is important to make every encounter count for health – and that includes oral health, which is important for general health and wellbeing. Health professionals definitely need to work together to support people with mental health problems, who can often have poor oral health and require support to reduce their risks of disease and access appropriate care. This is an important area for workforce capacity building and networking.”
Professor Gallagher also pointed out a recent paper, which concluded that “psychiatric inpatient settings may provide important opportunities for oral health promotion and intervention [and] this is a neglected component of inpatient care”. Many of the patients who took part in this particular study did not even have a toothbrush or toothpaste before attending a dedicated inpatient dental clinic.