Where Dental and Mental Health Meet

A Perspective:  Integrating Behavioral Health Services in Dental Clinics

For Huong Le, Chief Dental Officer at Asian Health Services, a regular dental visit with a teenager drove home the critical connection between dental and mental health.  “We took care of her teeth and I complemented how beautiful her teeth were, and she replied, ‘I don’t care, because I’m just going to kill myself.’”

After probing from Le, the young woman explained that she was a foster child, in a bad home environment, and depressed. “So, we stopped the visit to talk to her about suicide and the suicide hotline.”

Le points to the unique dental environment that opens up the potential for building trust.  As a dentist, our visits are usually long visits. So we get to know our patients. I’ve listened to a lot of life stories.”

The nature of teeth can also reveal what may be happening with patients’ mental health.  The teeth, explains Le, reveal that patients may be experiencing domestic violence, bulimia or anorexia, drug use like methamphetamine abuse. Oral pain can also contribute to mental health challenges when a patient is unable to chew food or even smile.

Le notes that time in the dental chair often surfaces behavioral or emotional needs among her elderly patients as well. I had a dental patient that kept coming back every day for adjustments. She was in her eighties and she just wanted to come in just to talk to me.  There was nothing wrong with her dentures, she just needed somebody to talk to.”

Being aware of the opportunity to connect, Le believes, the community health dental profession can begin integrating dental and behavioral health. “Even though we are in a community health setting, I still feel like we are segregated (between dental, behavioral, medical)…We are not counselors, we are not behavioral health specialists, but we have so many opportunities to talk to our patients and start that initial conversation. Then we can connect them to specialists who are actually trained in dealing with those issues.”

Last year, the dental clinic integrated behavioral health screening questions in their check-in procedure for seniors. “The very first day that we implemented the screening, one of our patients wrote that she was contemplating suicide…of course I immediately emailed our behavioral health manager to let her know that we had a patient in need of help. We set up an appointment and she received the help she needed.”

Integrating dental and behavioral health begins with talking about these issues at professional convenings, developing tools for practitioners, and building physical spaces where dental patients can connect to behavioral health needs.

The proposed Asian Health Services dental clinic expansion will include 9 operatories, including 2 pediatric suites, and a dedicated counseling room, cementing the integration between behavioral and oral health in one location. The new clinic will also enable behavioral health screenings to more patients as well as dental screening for referred behavioral health patients.