Descriptions of Difficulties in Dental Treatment of Psychiatric Patients

Abstract

The authors have conducted a turvey to obtain possible causal factors explaining the difficulties in dental treatment of psychiatric patients. The subjects were 53 psychiatric patients who had been treated during the period from Sep. '97 to Oct. '97 in the outpatients or inpatients unit in Karasuyama Hospital Showa University School of Medicine. The authors obtained the following observations of these patients on a first-come, first-served basis.
This survey showed the following aspects of dental treatment ; At intake time, unclear chief complaints, unclear verbalization and unidentified complaints were found. In diagnostic time, the difficulties that the authors found were the elevation of the threshold of patients' perceived pain, patients' general indifference, the degenerated ability of verbal expression and poor oral hygiene. In treatment time, difficulty of patients' opening mouths, difficulty of breathing through nostrils, involuntary movement, occlusion anomaly, negative attitude toward treatment and patients' delusion and fears were observed. In addition, for the difficult points of the oral hygiene, dry mouth, periodontal disease, gingival hyperplasia and deposit of dental calculus could be listed.
Through this survey, possible solutions of difficulties in dental treatment for the patients with mental illness have become more clear. Regarding intake and diagnostic time, it was useful to take enough time to treat and to get patients' information from their families and care takers in order to deal with the difficulties written above. In diagnostic time, the authors found that the majority of the problems found in the dental office could be solved when authors had patients take proper postures. It was, however, often necessary to use mouth gags and restraining belts.