Mental Health Problems As Barriers to Dental Care in Community-Dwelling Adults in the United States

Background/Purpose: The physical health of persons with mental health problems has received heightened attention in recent years. A less examined domain of physical health is oral health. Accumulating evidence has shown that persons with mental health problems have poorer oral health than the general population. They have greater risks for tooth decay, periodontal disease and tooth loss, and subsequently increased demand for dental restorations, periodontal treatment, and dental extractions. Poor oral health is associated with increased risk for other physical illnesses, additional stigmatization, potentially fatal infections, and reduced quality of life. Therefore, oral health should be regarded as an important health issue for persons with mental health problems.

Despite higher risks for dental diseases, little is known about dental care utilization among persons with mental health problems. The primary objective of this study was to assess the longitudinal association of mental health problems and dental care utilization, expenditures, and barriers to dental care.

Methods: Individuals aged 18 and older (n=31,056) were drawn from Panels 13 through 15 of the Medical Expenditure Panel Survey (MEPS). The panel design features 5 rounds of interviewing covering two full calendar years. The key independent variable, having mental health problems at the first year of the survey, was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6), a standardized screener for past-year mental health problems, such as anxiety or mood disorders. Four outcome variables were measured at the second year of the survey, including adherence to annual dental checkups, total number of past-year dental visits, past-year dental expenditures, and barriers to dental care. All measures were self-reported. Logistic regression models were estimated for binary response variables. Zero-inflated negative binomial models were fitted for total number of dental visits. Generalized linear model (GLM) with a gamma distribution using a log link was applied to estimate dental expenditures. All models were estimated using Stata to account for the complex survey design of the MPES, adjusting for socio-demographic characteristics, geographic region, urban/rural residence, general health insurance, and dental insurance.

Results: Adults with mental health problems were nearly 40% less likely to adhere to annual dental checkups for preventive purposes (OR=0.65, p<.05) and were twice as likely to report barriers to dental care compared to those without mental health problems (OR=2.03, p<.05). Although adults with mental health problems did not have significantly more dental visits, they spent 20% more on total dental expenditures (exp(b)=1.20, p<.05).

Conclusions/Implications: Adults with mental health problems appear to underutilize preventive dental care and experience significant barriers to accessing dental care. The significantly higher dental expenditures but comparable number of dental visits among dental care consumers with mental health problems suggest that these visits are probably more resource intensive, indicating greater needs for advanced treatment. In addition to expanding adult dental coverage, mental health professionals, dentists, and other providers should establish a formal collaboration and referral system to facilitate the utilization of preventive and other necessary dental care among persons with mental health problems.