Case Example A:

“Can you help me with my teeth?”
This 30-year-old African American woman participated in the outpatient psychiatry program at a county hospital in Seattle. She approached PED, a volunteer dental hygienist in the program, with a request: “Can you help me with my teeth?”

Since she had avoided smiling, her oral health problems were not immediately obvious, but clinical examination revealed the worst dental condition in this clinician’s experience—severe periodontal disease, gross caries, and nonrestorable teeth. She had a complex medical history that included schizophrenia with hallucinations, a fear of needles, lupus erythrematosus, Sjogren’s syndrome, and substance abuse (though she last drank 10 years previously). She was eligible for Medicaid funded oral health care.

This married patient became pregnant before treatment could begin. Due to this and her pre-existing medical conditions, it was more than a year before treatment could proceed. The volunteer dental hygienist helped her coordinate appointments to deal with dental emergencies during this time. Eventually, the patient’s teeth were removed under general anesthesia in an operating room. When her denture finally was delivered four months later, her smile was broad.

Notes
This is an extreme example, but this patient illustrates the potential for dental devastation that can result from years of medication effects, poor diet, substance abuse, and lack of professional care and dental maintenance.

Although the patient had hallucinations and delusions, she was very cooperative and treatment elicited no unusual behavioral problems. The dentist used a slow, gentle approach, and over time, the patient developed trust and came to know what to expect from the dentist. Several years later, this patient is now taking care of her two sons, and despite her health problems, appears to be doing well.