Survey of Non-Dental Providers' Assessment and Management of Xerostomia in Patients with Mental Health Disorders
Murray, Nicole Robin
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<bold>Introduction</bold>: Approximately 26% American adults suffer from a diagnosable mental disorder, and 6% of the population suffers from a severe mental illness. Individuals with mental health disorders often have poor oral health, which may be exacerbated by rich diets, heavy tobacco use, and difficulty in accessing care. In addition, medications used to treat mental health disorders have side effects that can be detrimental to the tissues of the oral cavity. Xerostomia (dry mouth) is reported to affect one-fifth of patients taking antidepressants, with presence and severity of xerostomia positively correlated with the number of medications taken. It is unclear if possible xerogenic side effects are discussed with patients by healthcare providers prior to beginning treatment in the medical care setting. The purpose of this study is to survey prescribing healthcare providers to determine what non-dental providers know about xerostomia and to examine what information about potential side effects, if any, these practitioners provide patients before beginning pharmacological treatment for mental illnesses. <bold>Methods</bold>: Representative samples of health care providers in King County, Washington (125 primary care physicians, 50 nurse practitioners, and 75 psychiatrists) were mailed a 31-question survey. Participants were asked about their prescribing practices, knowledge about oral health side effects of medications, consideration of oral health side effects when prescribing psychotropic medications, and frequency of assessing patients' oral health. Responses were summarized in each area with regard to oral health knowledge and willingness to assess patients' oral health. <bold>Results</bold>: The response rate to this survey was 40%: 101 total responses, with 45 primary care physicians, 20 nurse practitioners, and 36 psychiatrists responding. The average age of responders was 56.7 years, with an average of 24.6 years within their profession. The majority of providers (90%) reported they evaluated oral health by "appearance of teeth," but what specifically is evaluated is unclear because far fewer providers reported assessing missing teeth, presence of plaque or calculus, looseness of teeth, or saliva consistency. Providers were less likely to assess the oral health of their patients being treated for a mental illness than those without. In addition, while 91.6% of providers reported that they have at least some patients who report xerostomia, knowledge of recommended treatments for dry mouth symptoms appears to be lacking. <bold>Discussion</bold>: This survey illustrates the complexities of treating patients and managing adverse medication side effects. While this survey identifies gaps in oral health treatment in the non-dental setting for patients with mental health conditions, future studies are needed about the specific barriers to providing adequate oral health recommendations to patients with mental illness, for this vulnerable population is in great need for holistic medical care, including dental care. Ultimately, improved provider management of oral needs would allow for not only an improvement of oral health (e.g. reduction in caries, periodontal disease) but also larger issues, such as improved quality of life and improved management of comorbid chronic conditions.
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