The Effects of Mental Health on Periodontal Care

Periodontists are now more than ever more concerned about the overall health of their patients.  Not only oral-systemic issues, but mental health issues are now the cause of increasing concern during this time of the Covid-19 pandemic.

The World Health Organization estimates that 1 in 4 people deal with mental health issues worldwide, and the numbers are increasing.

When patients are experiencing high levels of stress, the value of their personal oral care may decrease due to the priorities they may encounter in their daily lives.

For patients, the fear of having dental treatments was common before the pandemic.  Now as people are becoming more and more isolated, stressed, and afraid; their dental fear levels may increase.  Increased stress levels can play a significant factor in the success of the care we provide, and as we all know, the patient’s participation is paramount in the success level of the outcome of their treatment.

To be effective in helping others, we need to be strong, capable, and in good mental condition ourselves.  We are always concerned about the welfare of our patients, but what about the staff, and yourself?  This includes you!  If you are absorbing the added stress and not taking the time out for your personal TLC, things that seemed manageable before may catch up with you.  Self-care is vital.

It is not only extremely important to consider the increased stress levels of your patients, but yourself and your team members as well.

Here are a few actions that can help address and manage the mental health and welfare for both patients and staff.

Take time out for Team training as a group. 

Investing in your team with group training is highly beneficial.  Such social interaction encourages camaraderie and inclusiveness to offset the current atmosphere of isolation they may be experiencing outside of the practice.  Approaching the team training as a “game”, can lift everyone’s spirits and set the mood encouraging a positive outcome.

Take advantage of the opportunity to review issues that you never get the chance to communicate during the regular workday.  Many nuances around the practice that we all “wish” would improve that never really seem to get the attention they deserve.  Often these items can be related to the quality of tasks such as, properly completing chart entries, accurately recording clinical details, documenting chart notes without type-o's, and grammatical errors.

Taking corrective action can be difficult because it may seem to come from a place of negativity.  Instead, a better approach would be to use it as an opportunity to spend time with the team to build their confidence levels.  

Utilize real examples that you have discovered multiple times in the practice and create hypothetical examples so that no one feels put on the spot or becomes embarrassed.  Roleplaying activities as a group will create a sense of team allowing everyone to develop a better understanding of your practice processes.  You can also take this time to implement new methods within the practice.

An idea to address the issue of patient mental wellness would be to implement a process to record, assess and track changes in the patient's stress levels and or overall lifestyle situation which could potentially affect their dental care.

Implement a patient wellness assessment checklist. 

The most important factor in any treatment plan is a proper diagnosis. The ability to effectively assess where a patient is emotionally is often difficult to pinpoint. 

Create a “Patient-Centric” wellness plan, to help your team more effectively engage with patients.  Use it to help your team understand how various aspects affect oral health and overall wellbeing.  Implementing deliberate and specific measures, you and your team will be more equipped to better manage the patient.

Providing the team with tools to help understand how to identify the patients' emotional and mental health status; will offer a more well-rounded environment and help enhance the most influential aspect of patient care, the patient themselves.

Here are a few ideas about how to approach it.

Comprehensive Intake:

Create a structured data collection system such as a checklist in a Word document, or use the forms in PANDA Perio which will act as an interactive, comprehensive data collection platform to consistently track a more complete level of detail, in an easy to use click-through process.

Just like tracking medical health history information, create an additional form that follows a consistent process to review the patient’s emotional status, mental situation, and personality traits. 

Below is an outline style example, in PANDA Perio these can be point and click answer lists to eliminate the need to type.

1. Patient-Centric Identification Examples Include:
   1. Social Habits and Environment:
      1. Habits: Smoking, tobacco, Vaping, Alcohol, Drugs
      2. Exercise levels: Excessive, 3 to 5 times a week, Occasional, Sedentary

• Family/peers: Family, Social Activities

1. Environment: Happy at home? Or confined to a small condo with roommates? Here is where you can find out about their perspective and outlook toward what is happening around them.

1. Personality: Type A/ Driven, Social/Inspiring, Steady/ Stable, Analytical/ Accurate
2. Dental Visit Preferences:
   1. Special needs: Do not tip too far back, Likes to hold suction, Gags easily, Only sees Suzie RDH
   2. Appointment preferences: Preferred time of day, Preferred day of the week, the Preferred form of contact (Email, Text, Telephone)
3. Motivation level: High, Moderate, Low
4. Preferred Motivational Styles: Positive reinforcement, Feedback Reporting/ Scoring, Achievement/ Task Driven, Coaching and Mentorship, Data/ facts and documentation, and analytical resources.

The above, are a few common things often found within a patient history but maybe isolated and infrequently reviewed.  This is a small sample that probably could evolve into an entire CE workshop.  You can enhance your own lists as you grow and evolve your practice system. 

One important consideration is to approach the data collection process casually as opposed to an abrupt checklist.  Some of the information collected may be of a personal nature, and best suited for a conversation where the patient is at ease.  Start by listening and expanding into other areas of their life, during the interview process.

When more care is given to the patient’s specific concerns, you will be able to effectively track their stress level to monitor increases and decreases in motivation.

Provide valuable output:

Focusing on gathering more insightful information, will alleviate the patient’s stress levels while under your care.  Working toward building trust and confidence gradually over time helps to improve the patient’s overall motivation.

Here are a few ideas to help put your newfound concepts to good use and complete the patient care improvement process.

1. Send a thank you card after hygiene visits with notes about their marked improvement. As a motivating bonus, include a copy of PANDA Perio’s Graphical Patient Motivation Report.
2. Call to follow up with the patient if they had increased concerns or problems while visiting your practice, just reminding them that you were listening could make a lasting impression that you care.
3. Keep a referral source handy of a respected and trusted psychologist or therapist, so that if a patient is experiencing a low, he or she can be referred to a specialist who can help them through their difficult times (no reason you cannot refer out for mental health as well as other specialties).
   
   

Taking care of patients from a holistic standpoint does not “cost any extra” and the benefits are exponential.  It's more about being mindful than “doing more things”. Showing patients that you care about them as a person,  will increase trust and loyalty and encourages them to successfully contribute to their own success. 

Getting your staff involved in this process completes the cycle to create a positive atmosphere, and increased well-being or everyone.  Right now, we need each other to stand together more than ever.

In closing…

What about you?  Did you plan that family outing, schedule that golf game, or take that day off to go fishing?  Take a minute to get outside and do the things you love, or order that new time-saving solution (PANDA Perio) so you can get out from under the paperwork. With PANDA Perio, you will have more time to take care of yourself and do the things that are the most important, starting by taking care of yourself first.

 References * https://www.deltadental.com/grinmag/us/en/ddpa/2017/wellness/oral-and-mental-health-connection.html, https://www.dentalhealth.org/mental-illness-and-oral-health , https://www.latimes.com/lifestyle/story/2020-07-02/going-next-dentist-visit-coronavirus-era-changes

https://www.dental-tribune.com/education/crushing-candy-the-mental-health-pandemic/

https://www.wolterskluwer.com/en/expert-insights/5-strategies-for-providing-effective-patient-education,