Description

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Mood disorders are characterized by disturbances of one’s mood, thought and behaviour resulting in severe distress and loss of control.

Bipolar disorder is one type of mood disorder characterized as being episodic and recurrent in nature and often manifested by two diametrically opposed moods: mania and depression. While listed in the top ten of the most debilitating of all non-communicable diseases worldwide, misdiagnosis remains common particularly in the early stages of the disease when an individual presents only with depressive symptoms having no established history of mania or hypomania.

Both manic and depressive episodes result in significant impairment in social and occupational functioning resulting in an inability to work and subsequent loss of employment, alienation from family and marital instability. Poor insight and judgement often result in substance abuse.

Oral manifestations of depression can include: xerostomia, poor oral hygiene, rampant caries, missing teeth, poorly fitting dental prostheses, advanced periodontal disease, orofacial pain and candidiasis. Lifestyle changes including poor diet, substance abuse and overall neglect will exacerbate these oral findings.

Patients with mood disorders often have difficulty with attention, concentration and motivation. Patients exhibiting hypomanic or manic behaviour can be easily distracted and often forget what they have been told with respect to their dental needs. Depressed patients generally remain apathetic and withdrawn with a reduced capacity to listen to and comply with instructions.

Any dental regimen must be as brief and flexible as necessary during each stage of the illness. By understanding and recognizing the signs and symptoms that would constitute hypomanic, manic and/or depressive behaviour, any discussion of treatment options and ultimately informed consent may take place in as rational a context as possible.

The dental professional can contribute to increased feelings of self-worth and self-esteem for these patients and it can be a truly rewarding experience.

Speaker Biography

David B. Clark Bsc.,DDS,MSc(Oral Pathology), FAAOP, FRCDC

Dr. Clark was Clinic Director, Dental Services at Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario from 1988-2017 and is an Associate in Clinical Dentistry, Department of Oral Medicine, Faculty of Dentistry, University of Toronto.

He obtained his DDS at the University of Toronto in 1976 and his MSc. in Oral Pathology at the University of Western Ontario in 1986 and is a Fellow of the Royal College of Dentists of Canada, the Pierre Fauchard Academy and Academy of Dentistry International. He received the Award of Distinction for his dedication and contributions to the field of Continuing Dental Education in 2015, awarded by the Academy of Dentistry International.

His hospital-based practice was devoted primarily to the general dental care of individuals undergoing primary care for various forms of psychiatric illness often co-existing with other medically compromising conditions.

He participates in the teaching of the undergraduate dental curriculum relating to the topics of Oral Medicine and Oral Diagnosis at the Faculty of Dentistry, University of Toronto. He is also a part-time clinical instructor (Dental Hygiene, Year 2) at Durham College, Oshawa, Ontario and George Brown College, Toronto, Ontario.

He has lectured internationally since 2005 on the subjects of psychiatric illness and its impact on the individual and dental management considerations; oral care and the geriatric patient; and a review of clinical oral pathology.