Addressing Oral Health Disparities in Individuals with Mental Health Problems

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DESCRIPTION (provided by applicant): This proposal for a K23 Mentored Patient-Oriented Research Career Development Award will provide the candidate with five years of continuous mentored support and additional training in the investigation of risk factors that contribute to the complex relationship between poor oral health outcomes and mental health problems. The long-term goal is for the candidate to become a leading independent investigator in reducing oral health disparities by understanding the ways in which psychosocial factors impact how individuals engage in oral self-care and dental treatment seeking. The candidate received her PhD in Clinical Psychology at the University of Kentucky, completed one year of predoctoral Health Psychology internship training at the University of Florida, and completed three years of NRSA postdoctoral training in the Department of Dental Public Health Sciences at the University of Washington. This award would allow the candidate to evolve into an independent investigator and would prepare the candidate to successfully mentor MS and PhD candidates in oral health disparities research. The training program consists of two phases: a didactic component emphasizing courses in epidemiology; biostatistics; research methods; and health services research, and a research phase involving the investigation of factors contributing to the complex relationship between mental health problems and poor oral health outcomes, such as avoidance of preventive care and delays in necessary dental treatment. Four specific aims are proposed in this training application. Specific Aim 1 will examine the relationship between mental health problems and unmet dental needs in non-institutionalized individuals through a retrospective analysis of a national health services utilization survey. Specific Aim 2 will examine, through individual interviews with non-dental health care providers, what oral health recommendations they currently give to patients with mental health problems and their willingness to intervene in patients' oral health. Specific Aim 3 will determine, through surveys with individuals with mental health problems, the oral health status of and barriers to oral health care faced by individuals in this underserved population. Finally, Specific Aim 4 will determine the feasibility of a pharmacy- based oral health pilot program with individuals taking psychotropic medications. Peter Milgrom, DDS, Professor of Dental Public Health Sciences, will chair a multidisciplinary Mentoring Committee consisting of faculty members from the University of Washington Departments of Pharmacy, Health Services Research, Biostatistics, Dental Public Health Sciences, and Department of Oral and Maxillofacial Surgery. Completion of the proposed Research Plan will provide valuable information regarding the complex, multifactorial relationship between mental health problems and poor oral health. Directly, psychotropic medications can cause dry mouth symptoms harmful to oral health. Indirectly, mood and anxiety disorders can interfere with motivation for adequate oral hygiene and willingness to seek preventive dental treatment. Many individuals with chronic mental health problems come from disadvantaged backgrounds or are disabled and face financial barriers to purchasing dental care. What is not known, however, is what individuals with mental health problems know about their oral health risks and what recommendations, if any, they receive from dental and non-dental health care providers about these risks. This work is expected to show that while people with mental health problems are at an increased risk for poor oral health outcomes, these individuals do not receive consistent recommendations about their oral health, particularly in the absence of a regular source of dental care. Ultimately, this work will result in an R01 application focusing on the role of non- dental health care providers in reducing health disparities in this underserved population. Public Health Relevance: The public health relevance of the proposed Research Plan relates to the use of non-dental health care providers in the delivery of oral health counseling to individuals who lack access to regular dental care. Completion of the studies in this proposal will lay the groundwork for future interventions to increase access to oral health resources for individuals in underserved populations.