Dealing with SMI

Severe mental illness (SMI) is a life-altering disease that affects people just as they are beginning to discover the freedoms of adulthood.

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by Ann-Marie C. DePalma, RDH, MEd, FAADH
amrdh@aol.com

Severe mental illness (SMI) is a life-altering disease that affects people just as they are beginning to discover the freedoms of adulthood. Life, instead of being full of dreams and hopes, is full of dissolution, grief, and fear. Normalcy is replaced with life-altering medications and hospitalizations. Families and friends are thrown into the panic of not knowing their loved one’s prognosis and recovery.

Until recently, SMI was unmentionable, and those whose lives were affected had to deal with the stigma of their diagnosis. Lisa Knapp, RDH, BS, knows all too well the impact SMI can have on people, not just with respect to overall functioning, but also on the oral health of the affected person. Lisa has developed two programs on SMI, one for dental professionals and one for mental health professionals, with the goal of improving the oral health of individuals with SMI, called “Clues to a devastating illness: Severe mental illness and oral health.”

The program offers a platform for understanding several mental health disorders such as schizophrenia, bipolar disorder, and chronic depression, along with the oral manifestations these disorders and medications present. Lisa created the program to educate dental professionals in treating this underserved population.

Goals of the program include:

  • Discussion of the predisposition, prevalence, and related pathophysiology of schizophrenia, bipolar disorder, and chronic depression
  • Recognizing risks, causes, signs, symptoms, and treatments for mental disorders
  • Identification of the oral manifestations of mental disorders and the modifications of dental treatment necessary in treating these patients.

All members of the dental team are encouraged to participate in the program. Severe mental illness affects many lives, and many people have a relative or close friend affected by these illnesses. It is estimated that 1% of the world population is affected by schizophrenia, 1.2% by bipolar disorder, 15% by chronic depression, and one in four families by SMI.

Due to the variety of medications used to treat SMI, many patients exhibit dry mouth. This, coupled with the negative symptoms of SMI, causes many of these patients to lose teeth. Access to care is minimal due to the nature of the illness, and due to a variety of factors these patients often do not seek regular dental care. Dental patients affected by mental illness need to be treated with special care and understanding. This program offers dental professionals insight into the world of SMI and how to treat these patients safely and routinely.

Lisa is a 1977 dental hygiene graduate of Allegany Community College in Maryland. She earned her BS from the University of Maryland in 2003. She had enrolled in the master’s in dental hygiene program when her life took a drastic turn. Her son, Jordan Robert Pence, was diagnosed with SMI at age 20. She became his caregiver, dedicating herself to learning all she could about SMI. She witnessed firsthand the devastating effects of the disease until Jordan died in June 2008 at the age of 24. Not only did he lose the ability to enjoy life, but within a year of diagnosis, after he took prescribed medications, his oral health deteriorated. His medications caused xerostomia, and his teeth decayed so severely that over $10,000 in dental restorations were needed. Lisa was fortunate to be able to provide him with the treatments, but many SMI individuals are not as fortunate, so they experience severe pain and edentulism. When Lisa presented an oral health exhibit booth at the 2008 National Alliance for the Mentally Ill (NAMI), she received positive feedback from consumers and mental health professionals. Many people feel that dental health must be at the forefront of total health care treatment for those with SMI.

People regulary thank Lisa for using her grief to positively impact the lives of many. By educating dental professionals and mental health professionals, she keeps her son’s legacy alive. She is thankful for those who have supported her efforts, primarily NAMI, GC America, Orahealth, Dentek, and Sunstar Butler. (Lisa is a 2008 Award of Distinction winner.)

For information on Lisa’s program, contact Lisa91156@aol.com.

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