New research has showed that those with severe mental health conditions are facing a “dental crisis”. The worrying findings shows that those with such conditions are likelier to have further health difficulties.

Those with mental illness are already likelier than the general population to have oral health problems [1]. This is due to a range of reasons. But as this research shows, the problem is worsening, not getting better.


The study, published in the highly respected International Journal of Environmental Research and Public Health, was carried out by researchers at the University of York [2]. It’s findings paint a worrying picture for those with mental illness.

The study involved participants that had Bipolar Disorder, Schizoaffective Disorder or Schizophrenia. These three conditions are widely seen as the most severe mental illnesses. This isn’t to belittle any other condition though – anyone with any mental health condition can face incredibly difficult times.

These conditions often involve elements of psychosis – such as hallucinations or delusions. Other psychosis-focused disorders exist too. Approximately 0.95% of the British population have one of these conditions [3].

The research involved interviews with 7 people with one of the above conditions. These interviews involved the researcher asking the participant about their experiences of caring for their oral health and their use of dental services [2]. They were also asked about whether or not they had faced any challenges in the past in regards to accessing care [2].

The researchers collated the responses, and found the following main issues existed:

  • Impact of mental health conditions: The participants mentioned that the burden placed on their life by their mental illness meant that oral health wasn’t a priority. This is very understandable – given that for many people, day-to-day survival is a tough challenge in itself [2].
  • Lack of integration of mental and oral health treatment: Oral health appears to be completely neglected in mental health treatment. There was a suggestion that when being treated for mental health, that patients should be encouraged to care for their oral health, and told about the importance of oral health. As part of this, oral health professionals have not been educated on the need to tailor dental care for the mentally ill [2].
  • Cost: Oral healthcare is not free in the United Kingdom, unless a person is receiving state benefits. But benefits cannot always cover other living costs. For those that are in employment, affording dental care isn’t easy either. Then there is also the problem where those with severe mental health conditions find it very challenging to maintain regular employment [2].

It is clear based on the above that there are several barriers facing the mentally ill in seeking oral health treatment. Improved education of oral health professionals is a must. Moreover, the integration of oral health into mental health treatment could have a very positive effect.

Therefore, involvement of mental health professionals could result in their patients realising the importance of caring for their oral health. This is something that figures at the very top of the NHS should be taking into account.

The research did state that one of the limitations of the study was the small sample size [2]. While this is important to remember, it should also not be forgotten the fact that so many people with severe mental illnesses struggle with their oral health.

The worrying cycle

Oral health and mental illness are innately linked, and a vicious cycle can develop between them. As seen in the diagram below, there is an ongoing cycle between poor mental health, ignoring oral health, requiring oral health treatment, and back to poor mental health.

This cycle clearly results in worsened mental health, which causes poor oral health – eventually reinforcing poor mental health. There are clearly many problems that this cycle creates, and can actually result in physical health complications too.

Causes of Poor Dental Health

As well as the barriers mentioned above, and the vicious cycle mentioned above, there are other considerations. One of the leading issues is the common side effect of medicines like antidepressants and antipsychotics – dry mouth.

Dry mouth can have a terrible impact on teeth, as saliva is one of the main causes of keeping acid levels in our mouth at a neutral level. Less saliva means tooth decay can worsen, and that teeth don’t get the protection they need.

Dry mouth is one of the most common side effects of antidepressants, antipsychotics and mood stabilisers – all of which are used by millions of people for their mental health. Sadly, this is often a necessary evil for the mentally ill, with the good that these medications do outweighing the bad. A good way to lessen the damage is to sip water frequently throughout the day.

An ongoing issue in the United Kingdom currently is that the vast majority of dental clinics are not accepting new NHS patients. Instead, more and more dental clinics are turning to private dental care – given the lucrative possible income.

So even for those seeking dental health, it can be very difficult just to be seen by a dentist. Many have to wait until they are in excruciating pain before calling the non-emergency number 111, who can then arrange an emergency appointment. No one should need to wait until they are in terrible pain to receive dental care.


This research clearly shows that inequalities exist between those with severe mental illness and the general population when it comes to oral health. There is not enough education on mental illness, and it makes an already vulnerable population face more struggles.

Going forward, there is much work to do. This is part of a wider societal issue where those with severe mental illnesses are not receiving the care they need in order to attain better overall wellbeing. Hopefully, improvements will follow very soon.

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[1] Kisely, S., Baghaie, H., Lalloo, R., Siskind, D., & Johnson, N. W. (2015). A Systematic Review and Meta-Analysis of the Association Between Poor Oral Health and Severe Mental Illness. Psychosomatic Medicine. 77 (1): p83-82.

[2] Mishu, M. P., Faisal, M. R., Macnamara, A., Sabbah, W., Peckham, E., Newbronner, L., Gilbody, S., & Gega, L. (2022). A Qualitative Study Exploring the Barriers and Facilitators for Maintaining Oral Health and Using Dental Service in People with Severe Mental Illness: Perspectives from Service Users and Service Providers. International Journal of Environmental Research and Public Health. 19 (7): p4334.

[3] Hayes, J. F., Marston, L., Walters, K., King, M. B., & Osborn, D. P. J. (2018). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry. 211 (3): p175-181.