215 The Development of an Oral Health Nursing Tool in Patients with a Psychotic Disorder It is frequently asserted that poor oral health is related to an unhealthy lifestyle. However, the connection between improving oral health by improving lifestyle has not been scientifically proven. Risk Factors Caring for teeth involves more than just brushing, flossing, and visiting the dentist regularly. Understanding the risk factors that affect oral health is also important. General health is linked to oral health, and vice versa. There are many risk factors that can arise from both physical and mental health conditions. Common risk factors for oral health include: • Mental health (such as stress or anxiety). Stress or anxiety can contribute to serious oral health conditions. Stress and anxiety suppress the immune system, making people more susceptible to disease and infection. Stress affects oral health, leading to a dryer mouth more quickly. • Fear of the dentist? Talk about it. Dentists and dental hygienists are there to help and are willing to discuss the situation. There are many options available, including taking anti-anxiety medication before an appointment or using conscious sedation. • Medication. Side effects of antipsychotics (e.g., clozapine, olanzapine, quetiapine) can cause dry mouth (xerostomia) or insufficient saliva (hyposalivation). This is covered in more detail in the “Medication” chapter. • Smoking and cannabis use. When people smoke, harmful substances like nicotine and tar are released into the mouth. Nicotine reduces the blood flow to the gums, making them less accessible to immune cells. It also prevents the gums from bleeding quickly, so someone may not notice if there is something wrong with their gums. Smoking also reduces saliva production. With a shortage of immune cells and saliva, there will be fewer defence agents in the oral cavity, increasing the risk of plaque, cavities, and subsequently gum inflammation. Smokers have more plaque than non-smokers. If not carefully removed, plaque develops into tartar and cavities. Tartar causes gum problems such as gum inflammation. As the blood vessels narrow due to smoking, inflamed gums are noticed later, and by then there may already be penetration into the jawbone, potentially causing teeth to become loose and fall out. 6
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