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Medical Self Advocacy

Dental Health

Dental health contributes to general health and wellness, self-esteem and quality of life. For many people living with mental illness, dental health may be a low priority when other treatment and health issues must also be addressed. Cost and fear are routinely cited as the largest barriers to care. Additionally, an illness may lead to deterioration of self-care, and an individual may have no experience or history of engaging in dental care as part of his or her overall health practice.

Dental care is a key to good health overall, but in the last decade research shows that preventing cavities and gum inflammation is also very good for your heart. Recent studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works. Although there is more research underway to help understand this relationship more thoroughly, it is clear that your oral health affects your overall health.

Barriers to Dental Care

There are many barriers to access to dental care for people living with mental illness. They include cost, fear and the lack of access to adequate dental providers. The lack of culturally competent providers is common in many communities.

The Internet Journal of Dental Science reports that lack of knowledge about dental care, poor self care and embarrassment regarding neglected care, negative attitudes about dental health care, unrecognized dental treatment needs, inability or unwillingness to accept treatment and mistrust of dental health providers contribute to dental health neglect.

Unfortunately, Medicaid does not provide for payment of routine and preventive dental care everywhere. Some state programs cover only teeth removal and not prevention. Advocates are working hard to ensure access to dental care for people living with mental illness in state health care programs. People deserve good teeth and the good health that goes with them.

There are places that provide free medical and dental care for people who are uninsured or under-insured. Students in dental schools need practice, and provide good care usually at reduced rates. Students-in-training are supervised by attending dentists. In addition, public dental clinics do exist in communities across the country, and many of these offer specialist dental care to individuals with particular needs and medical conditions.

A new Web site that collects information on free medical and dental care in every state,, links to free and reduced-rate medical services for both children and adults. Some clinics and services may only be available to specific sub-population such as homeless or HIV-positive individuals. However, many will accept all people who want care. The Web site encourages you to provide feedback after you have had learned about the services in your area.

Causes of Poor Dental Health

Poor diet and an increased sugar intake, particularly sodas, are reported as factors in poor dental health as well as housing conditions, homelessness and access to privacy for personal hygiene. Smoking leads to an increased incidence of dental diseases as well, which is another reason for individuals to consider quitting smoking.

Some medications used as part of a treatment plan for individuals living with mental illness create side effects that impact dental health, the most common being a reduction in salivary secretions resulting in dry mouth. This has a big affect on dental health and increases the risk of cavities and other serious oral health issues.

Tips for Good Dental Care

Regular brushing and flossing of the teeth, using fluoride toothpaste and seeing a dental professional twice a year are just some of the things that people living with mental illness can do to help address their dental health needs as a part of their wellness initiative. Dental professionals can help identify problems before they become serious. If dry mouth is an issue, as it is for many individuals as a result of certain medications, a dental health provider may recommend a rinse or other oral product to relieve symptoms.


You should brush your teeth at least twice a day, ideally after meals, if you can. You want to make sure that you brush every side of every tooth. Start in the back and move forward in small, tooth-sized circles. Try to aim the bristles of your toothbrush at a 45-degree angle toward the gums, as this is where most plaque forms and builds up.

Try to brush for two minutes each time you brush your teeth to ensure that you get them as clean as possible. Never brush in harsh back-and-forth motions as this can cut the gums.


Many people don't realize the importance of flossing. Flossing between your teeth is essential for avoiding gingivitis and tooth decay. Gingivitis, one of the main causes of tooth loss in adults, can be easily prevented by flossing. Research shows that flossing can help prevent heart attacks and strokes.

A sticky substance called plaque forms on, and in between, teeth and is the main culprit of tooth decay. If plaque isn't removed, it combines with sugars and starches in foods we eat and produce acids that attack tooth enamel. While brushing your teeth removes plaque from the surfaces of the teeth, only flossing removes plaque that accumulates between them. Plaque also irritates your gums, which can cause gingivitis—when you gums become reddish-purple, tender and start to bleed. If the plaque is not removed with dental floss, the gums can eventually start to pull away from the teeth. When this happens, bacteria and pus-filled pockets can form and the bone that supports the teeth can be destroyed. After the bone is destroyed, teeth will loosen and likely have to be removed.

Dental Care, Mental Illness and Medicines

When visiting a dentist, it is important that individuals living with mental illness who are on medications share information on the specific medications and doses with their dental health provider. In addition to understanding any dental side effects, many medications may have negative side effects when combined with dental medications.

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