There’s a significant connection between mental health and overall well-being, yet the role of dental visits in this context is often overlooked. Dental hygienists spend considerable time with patients and are uniquely positioned to observe changes in behavior, mood, and physical symptoms that could indicate mental health concerns. By incorporating routine mental health screenings into dental care, hygienists can initiate important conversations that address not just oral health but overall wellness.
The unique role of dental hygienists
Through their ongoing relationships with patients, dental hygienists can detect subtle changes in behavior or mood that might signal a mental health issue. Research suggests that patients often confide in their hygienists, which presents an opportunity for them to identify mental health concerns early. This positions the hygienist as a key player in recognizing potential problems, making routine dental visits a chance to care for the whole person.1
The importance of early mental health intervention
Screening and support at the initial stages can alleviate symptoms and improve quality of life. Sadly, nearly 800,000 people globally die by suicide annually, including more than 45,000 in the US.2,3 Depression, a leading cause of suicide, can often be identified early through screenings during dental visits. Tools such as the PHQ-2 depression screening questionnaire enable dental hygienists to identify at-risk patients and refer them for further support, potentially preventing tragic outcomes.4
Incorporating mental health screenings in dental practice
With the right tools, integrating mental health screenings into dental visits can be straightforward. The PHQ-2 is an effective start, asking two key questions about interest in activities and feelings of depression over the past two weeks. A score of 3 or higher may warrant further assessment with tools like the PHQ-9.
These screenings can be incorporated into patient paperwork or conducted during appointments and allow hygienists to identify patients who may need additional support.4 Proper training ensures hygienists are comfortable conducting these screenings and can approach patients with sensitivity. By normalizing these conversations, such as saying, "We’re including some basic questions about your well-being as part of our overall health check," hygienists can reduce stigma and encourage openness.5
Building confidence in addressing mental health
Discussing mental health can be challenging, but with practice and training, hygienists can become more confident in these conversations. They should be able to recognize signs of common mental health issues and know how to initiate sensitive discussions. Practicing different scenarios can prepare them for patient reactions, making these interactions more manageable.
Regularly bringing up mental health in the dental setting is key to making these discussions feel less daunting. When mental health is visibly addressed, such as through pamphlets or posters in the waiting room, patients are more likely to recognize its importance.1
Respect a patient’s response to these conversations. Some may be more open, while others might find the topic uncomfortable. Establish boundaries while letting patients know they can discuss mental health whenever they’re ready. Ongoing education and collaboration with colleagues can help dental hygienists enhance their knowledge and skills in this area.
Establish a referral network for mental health professionals
While dental hygienists can identify potential mental health issues, treatment often requires specialized care. Referring patients to mental health professionals, similar to referring them to an oral surgeon, ensures they receive the appropriate support. Collaboration between dental and mental health services can significantly benefit patients.5
To implement a referral system, dental practices should establish a network of trusted mental health providers, such as psychologists, counselors, and social workers. Building relationships with these providers ensures that patients receive necessary care. A well-defined referral process should include identifying the need based on screening results, discussing the referral with the patient, providing resources, documenting the referral, and following up at subsequent visits.
Effective communication with mental health providers and with patient consent facilitates coordinated care and better outcomes. By offering a clear path to appropriate resources, dental hygienists can help patients improve their overall health and well-being.
Conclusion
As awareness of mental health grows, dental hygienists have a unique opportunity to make a significant impact. By integrating mental health screenings such as the PHQ-2 into routine care, building confidence in addressing mental health, and establishing a solid referral process, dental hygienists can provide comprehensive care that addresses both oral and mental health. Early intervention in the dental setting can lead to life-saving measures, highlighting the profound influence hygienists can have on their patients' overall well-being.
References
1. Simonsen CE, Martin SB. The role of dental hygienists in recognizing and addressing mental health issues in patients. J Dent Hyg. 2016;90(1):14-19.
2. World Health Organization. Mental health and suicide prevention. 2019. https://www.who.int/health-topics/suicide#tab=tab_1
3. National Institute of Mental Health. Suicide statistics. 2021. https://www.nimh.nih.gov/health/statistics/suicide
4. Kroenke K, Spitzer RL, Williams JBW. The PHQ-2: Validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292.
5. Lapidos A, Matulis R, Mockridge SN, Rulli D. Behavioral health in dental dettings: resources to support integration. J Calif Dent Assoc. 2024;52:5(1) doi.10.1080/19424396.2024.2353739
