B2B Healthcare Blog Based on SME Interview
A B2B blog offering guidance on mental health issues for dental hygienists, based on an SME interview for Friends of Hu-Friedy.
Suicide Awareness and Identifying Patients at Risk
FollowYou may be aware that there’s a strong connection between oral and mental health, but it’s easy for each discipline to overlook the links to the other.
People living with severe mental health disorders are more likely to find accessing dental care or treatment for their health conditions difficult — culminating in a 2.8-times greater likelihood of losing their teeth than the general public.
This May, during Mental Health Awareness Month, Friends of Hu-Friedy spoke with Sherri Lukes, RDH, MS, FAADH, a leader in dental hygiene education and research. Sherri is a vocal advocate for mental health, educating others of the warning signs in remembrance of her daughter who died by suicide and as she manages her own mental health struggles.
In this article, we’ll examine the connections between oral and mental health, explore what role hygienists can play, and review how you can navigate assessments and conversations with your patients.
The Interconnectedness of the Mind and Mouth
Oral health can impact mental health and vice versa, writes Antoinette V. Shappell, MD, and Pierre M. Cartier, DMD, MPH, in Psychiatric News. Poor oral health can impact a bevy of behaviors, from the way someone speaks or eats to how they feel about themselves — it can even curb their enthusiasm toward socializing.
Conversely, mental health problems can contribute to coping mechanisms like unhealthy eating, smoking, and drinking. It can also lead to a loss of appetite, low energy, pain, and dry mouth.
It makes sense: For someone struggling with mental health, it might require a lot of energy just to get out of bed, making the other items on the daily must-do list feel untenable. Toothbrushing and other oral health habits might fall by the wayside. Making an appointment and trying to visit a dentist’s office might cause anxiety or feel too onerous for someone with mental health issues, causing patients to delay dentistry — or stop going altogether.
Luckily, dental hygienists can help patients affected by mental health problems and lead with empathy, as the dental industry isn’t immune to these issues either.
How Dental Hygienists Can Help
As dentistry moves toward a holistic model of health, you may be asked to assess your patients’ mental health and risk of suicide.
But in an industry where time always feels scarce — you bring your patient back to the operatory, do x-rays and medical history, and perform all the procedures — where is there time to venture into a patient’s mental health?
“I know dental hygienists are like, ‘Yeah, I don’t have time to do one more thing.’ But the thing is, it was amazing to me when I was in private practice the things my patients told me,” Sherri says. “Because you know what? People just want to be heard. Yes, we are psychologists, too. Kind of like your hairdresser ... hygienists tend to be empathetic people in the first place. We’re there to serve. We care about our patients.”
To illustrate the unique relationships between patients and hygienists, Sherri says that while she was still relatively new to private practice, her patients brought her gifts when she was pregnant. She notes strong relationships between dental hygienists and patients can develop, and monitoring their mental health is another way to help.
Dentistry as Whole-Body Healthcare
Gauging your patients’ mental health may actually be one of the most important roles you can play in the health of your patients that might not be in your traditional job description.
Playing a broader role in your patients’ whole-body health can also solidify dentistry’s role in healthcare, Sherri says.” As long as we just fulfill the role of pickers and flickers and drillers and fillers, that’s all the general public’s going to ever see us as. But when we expand our scopes and show the patients that we’re interested in whole-body health, then they’re going to have more respect for us and see us as healthcare providers rather than concentrating only on the mouth.”
How to Navigate the Mental Health Assessment
Sherri says, “The assessment phase is the most important phase in dentistry” and takes little time. Hygienists can roll the Patient Health Questionnaire 2 (PH-2) into the medical history portion of the appointment to ask about their patient’s pleasure in doing things and their recent frequency of feeling down, depressed, or hopeless.
If a patient gives “yes” answers in the PH-2, dental hygienists can continue asking questions using the PH-9. Sherri says these questions provide so much insight into the patient’s oral health and recommended asking the questions orally — rather than using a written survey — to encourage patients to expand on their answers naturally.
What to Avoid
Sherri strongly believes in having these conversations, and she’s equally adamant about what not to say. “Don’t tell people to ‘Chill’ or ‘Take a chill pill.’ That’s so offensive,” she says. “Or, ‘It’s all in your head.’ Yeah, it’s in my head! My brain’s not working right!”
Lastly, she says that making light of the struggles of mental health and calling people “crazy” is incredibly hurtful.
Nudging Patients Into Improved Habits for Mental Health
Sherri maintains that when it comes to mental health, “There are so many things dental hygienists can do to help, and we’re all different, and it’s multifactorial. For some people, their mental health issues are situational … circumstantial. After a while, they go away. And for some of us, it’s chronic,” she says.
Talking about what helps you with your mental health can go a long way to deepen your relationship with your patients and help them open up.
Eating Healthy
Healthy eating doesn’t just improve oral health but bolsters an array of mental health benefits. A 2017 randomized control trial found that 32% of people with major depression went into remission after just 12 weeks of receiving nutritional counseling and eating a healthier diet.
Certain foods, such as those with vitamin D, antioxidants, and selenium, can help relieve symptoms of low mood or depression.
Exercise
Sherri backs the tried-and-true benefits of exercise while acknowledging that getting people with mental health issues to adopt more movement into their day can be challenging.
She recommends finding an accountability buddy because she knows how hard it can be to drum up the energy and motivation. “Without a person to nudge you and say, ‘Come on, we’re going to go out. We’re going to go out for a walk,’ you can’t oftentimes make yourself do it,” she says.
Meditation
Suggesting meditation can also be helpful to patients and is backed by research, though Sherri says some patients may think meditation is a little “out there.”
If patients get anxious during procedures, encourage them to begin building their meditation practice in the chair by using mindfulness meditation. Focusing on their breath and elongating their exhales will help slow down their sympathetic nervous system, which reduces that fight-or-flight feeling.
Encourage Them to Seek Help
For any patient who is exhibiting signs of mental health issues, it’s important to encourage them to find mental health support. Tell your patient to contact their primary care provider, who can refer them to a psychologist or psychiatrist, ensuring they’re in safe hands by assessing, monitoring, and treating their condition.
Know Your HIPAA Rights
Sherri recalls hearing a story of a dental hygienist who recognized that her patient was suicidal. The hygienist saw her patient every three to four months for a periodontal condition, and she watched him go downhill mentally, along with his comorbidities, including diabetes and neuropathy.
The hygienist had previously lost a patient to suicide and knew that if she was within her rights to take action this time, she could potentially save a life.
According to the Health & Human Services website, providers are not in violation of HIPAA if they take action when they see the risk of suicide in a patient. It reads: “Thus, to the extent that a provider determines that there is a serious and imminent threat of a patient physically harming self or others, HIPAA would permit the provider to warn the appropriate person(s) of the threat, consistent with his or her professional ethical obligations and State law requirements.”
The hygienist decided to call the patient’s wife. His wife started crying and said, “You see it, too? I thought it was just me.”
The next time her patient came into the office, he hugged her and said, “You saved my life.”
“We can make a difference,” Sherri says. “I feel very strongly about it.”
If you or someone you know is experiencing suicidal thoughts or a crisis, please text or dial 988 to be connected to the National Suicide Prevention Lifeline. This service is free and confidential.
Don’t Forget to Look After Your Mental Health, Too
The occupational stress of working in dentistry is high. Dental hygienists, in particular, can experience more anxiety and depression because of a variety of factors, including their emotional ties to their patients. You might feel frustrated when your patient returns for an appointment without improvement because they didn’t follow up at home. You understandably don’t want to inflict pain on the patient — or you become the pseudo-therapist, dealing with your patients’ dental anxieties. Or you feel like you may never be autonomous at work while working under the dentist — or stress from the office may boil over and impact your personal life.
Sherri recommends the American Dental Association’s resources, which offer practical advice and information on how to take care of yourself and your team.
Finally, Sherri reminds us that we all have a role in mental health: “I’ll go to my grave now advocating for mental health because, you know what? It’s everybody’s job. I don’t care if you’re the checker at Walmart. You could be the person who says something that keeps that person from going over the edge. It’s a very personal thing for me, and I’m convinced more every day that we have a role to play.”
Tell us in the comments:
How have you navigated assessments and conversations around mental health and self-harm at work? What techniques did you use that helped?
