Integrating dental, mental, and chronic care for overall wellness

When discussing recommended preventive screenings with patients, is routine dental care a part of the conversation? If not, there is compelling evidence for encouraging patients to maintain good oral health habits, particularly if they are being treated for certain chronic conditions.

Oral health plays a key role in overall health and well-being. Poor oral health can be both a cause and result of other medical conditions, including mental health conditions, making maintaining good oral health important when it comes to taking care of the whole self.

Because of the connection between oral health, physical health, and mental health, an integrated care approach involving dentists, medical doctors, and mental health professionals is key to addressing whole-person health. However, 33 percent of U.S. patients see only a medical practitioner and forgo dental care, according to a recent National Institutes of Health study.^[1]

Medicine and dentistry have historically been separated, with primary and oral health care typically being delivered in different settings and being paid for through different systems. This has made it difficult to coordinate medical and dental care, and this separation has led to missed opportunities to improve patient health outcomes.^[2]

Integrating medical and dental care, as well as behavioral health care, can include co-locating oral health resources in medical offices; integrating oral care into behavioral health settings; educating patients on the interconnectedness of oral health, physical health, and mental health; asking patients, especially those with chronic conditions, about their oral health and oral care regimens; and providing recommendations for proper preventive dental care.^[3] Understanding the links between oral health, physical health, and mental health is important for overall wellness and can lead to better health outcomes.

Medical conditions with known associations to oral health

Oral health has a bidirectional relationship with many medical conditions, including chronic diseases. Certain medical conditions can lead to oral health issues, and poor oral health can exacerbate certain medical conditions. The oral cavity is inextricably linked to chronic disorders, and neglecting oral health can accelerate the progression of chronic conditions.^[4] Some of the medical conditions that have a link to oral health are outlined below.

Diabetes. Due to the body’s lessened ability to fight infection, gum disease seems to happen more often and be more serious in those with diabetes. At the same time, gum disease can make it harder to control blood sugar.^[5]

Heart disease and stroke. Bacteria in the mouth that grows because of poor oral health, including gum disease, can enter the bloodstream and cause inflammation, which can lead to heart disease or cause a stroke.^[6]

Kidney disease. Xerostomia is prevalent in those with chronic kidney disease, which can lead to caries and oral infection.^[7] Chronic kidney disease, dialysis, and transplant medicines can weaken the immune system, which can make oral infections more dangerous. At the same time, the inflammation brought about by oral infections and gum disease can harm the kidneys and worsen existing kidney damage.^[8]

Sjögren’s syndrome. Sjögren’s syndrome can cause dry mouth, which can lead to oral pain, Candidainfections, sores, tooth decay and loss, gum disease, and other serious oral health conditions.^[9]

Lupus. Lupus can cause dry mouth, whether it be from medications or Sjögren’s syndrome, and gum disease. In addition, research has suggested that oral health problems can increase the risk of lupus flares.^[10]

Parkinson’s disease. Difficulty swallowing saliva brought about by Parkinson’s disease can lead to fungal infections at the corners of the mouth. Parkinson’s disease can also cause dry mouth, which can increase the risk of cavities. The physical effects of Parkinson’s disease, such as rigidity and tremor, can make it hard for those with Parkinson’s to maintain a daily oral hygiene regimen.^[11] At the same time, the inflammation brought about by oral diseases can exacerbate Parkinson’s disease and its neurological symptoms, and the eating discomfort that can come from oral diseases can lead to malnutrition, which can further deteriorate the health of those with Parkinson’s.^[12]

Amyotrophic lateral sclerosis (ALS). The muscular dysfunction brought about by ALS can make it hard for those with ALS to perform correct oral hygiene maneuvers and can lead to drooling and reduced salivary flow, which can all contribute to oral health deterioration, including tooth decay and periodontitis.^[13]

Huntington’s disease. The medications those with Huntington’s disease may take for symptomatic care can cause dry mouth, sialorrhea, and fungal infections. Chorea brought about by Huntington’s disease can make it hard for those with the disease to maintain oral hygiene practices, such as brushing and flossing, which can lead to caries, gingivitis, and periodontitis.^[14]

Pregnancy. Due to hormonal changes, pregnancy may make women more prone to gingivitis. Due to behavioral changes, pregnancy may make women more prone to cavities. Periodontitis has been associated with poor pregnancy outcomes, such as preterm birth and low birth weight, and women with a lot of cavity-causing bacteria during and after pregnancy can transmit these bacteria to their babies, which can lead to cavities early in childhood.^[15]

The link between oral health and mental health

In addition to the relationship between oral health and physical health, studies have shown a link to mental health, as well. A recent report by Cigna Healthcare^® highlighted some ways oral health can influence mental health. For example, periodontitis and its associated chronic inflammation can cause oral bacteria to enter the bloodstream, which can cause elevated stress hormones that affect mental health. Similarly, bacteria from gingivitis can cause neuroinflammation.

Conversely, mental health conditions can contribute to poor oral health. Those with a mental health condition may be more likely to put off preventive dental care and underutilize dental services, which can lead to tooth decay and loss, dental pain, and gum disease. Furthermore, having an eating disorder is linked to tooth erosion, while some medications used to treat certain mental health conditions can lead to decreased salivary flow rates, dry mouth, and caries. Additionally, depression is associated with teeth grinding, which can cause jaw pain.

Resources for providers and patients

Cigna Dental Oral Health Integration Program^®: Your patients with Cigna Healthcare Dental coverage who have specific medical conditions may be eligible for reimbursement of copays and coinsurance on certain dental procedures through this program. Patients can register for this program by submitting this form.

Preventive Care Services (A004) administrative policy: This policy provides information on preventive care services and how to integrate oral health assessments and referrals for dental care into wellness exams.