With clock ticking by, with only one and half hour left out for my lunch break which was to be due at 1 pm. Anxiously, there I was waiting whether I will get my patient for scaling or not. Just had we kicked off to clinical, tiresome job of taking history, doing manual scaling before starting ultrasonics more of, I felt like I was working as hygienist rather than a clinical student. Then there all of sudden I was handed with my patient and she was in her late forties who hailed from hilly area.

    Then the real problem started as soon as I made her sit, hurrying to start, asked her to open her mouth. The smell that came from her mouth, never had I smelt something horrible like that before. I couldn’t bear it at all, nor could I leave my patient in the lurch somewhere. Only solution was to put masks upon masks and bend your head and proceed. Anxiously, I started exploring her mouth after a short personal history. She has been taking medicine for mental illness for almost a decade and it was her first visit to dental OPD and most importantly a referred case by a psychiatrist.

    To my dismay, third degree halitosis was a minor one. If I was able to record all those findings and brought out my literature, I would have outmastered Professor Carranza. Lucky was Prof. Carranza I couldn’t, after carrying out with ultrasonics for about 2 hours, I couldn’t do more and we have planned it for next follow up and I have asked her to wait out there in waiting room, ensuring I would come in short while with her OPD card written with the performed procedure. When I came out there I couldn’t see her, waited for few more minutes searched here and there but to my dismay, she was already gone.


    The very next day as soon as I made it to the clinic I asked the nurse whether she made it to the clinic for her OPD Card. Never she did. For days I kept thinking about her reluctance to my instructions during treatment way I have explained about those rotating ultrasonic pieces. The way I feared during treatment. What if she threw tantrums during the procedure which we basically fear of. Nor she was accompanied by any visitor.

    Luckily she didn’t do anything wrong and I felt pity for her and her family who must have been ashamed to accompany her to the dentist stigmatizing her illness. Minimal care would have helped her way out if procedure of simple oral health care like brushing, flossing, and scaling than to undergo gingivectomy procedure that we all were planning to proceed in few more appointment. Nor I was able to take her contact number or address.

    For now, I am not sure whether she made to clinic again or not. Sometimes when I am not able to sleep I think of her, the miles of journey she had taken to reach here to get her aliment fixed from distant hills. Was I able to do justice to an already ill person who must have suffered a lot till date? A decade long history of Treatment for her mental illness.

    Then it sets me apart. Couldn’t a psychiatrist send her a few years later after she lost her all teeth accompanied by sinus fistula. Why is oral health issues alienated everytime? I pity upon the country budget system which does not seems to speak a word regarding its allotment in oral health sector. Concept of integrating oral health care along with mental health care seems to be far indeed. With ever increasing, quest of individual to outreach other in name of fulfilling desires.

    Ever increasing tension, failure to achieve leading dire consequences. Statistics showing increased suicidal rate, doubling depression ratios outlasting every year including minor to severe mental illness problem we are battling day by day. The patient I have took into account is just a representative. For sure there are thousand out there battling for simple care of oral health.

    With literatures I have gone through, preparing this I could barely found citation or scholarly articles linking approach of oral health care to mentally ill patient. Few were there, to my dismay, All of them were from either European or American university. Nor could I found among my neighbouring country. This surely shows the status of research and concern we have shown regarding these aspects.


    Literature show that considerable link between degrading status of oral health care among mentally ill patients. Problem increasing along with severity or vice versa. Have we considered it so? I don’t think so. Taking this into account integrated model of Oral health care among mentally ill patients can be taken in account.

    With many profitable and non-profitable organization working for betterment of these people we can integrate the care along with them. Scholarly article that have been published showing relation of oral health care approach among mentally ill patient in UK by mental health nurse, status was dramatically increased where patient were made aware day to day about brushing flossing only.

    In developing countries like Nepal, people have to cover miles to get basic health services. Sometimes I find integrating oral health care along with mental health care to be fancy. It’s tiresome but as we know most regional sub regional provinces have undergone specialty based care we can take this in account.

    Recommendations to create supportive dental environment and direction to improve the dental experience should be made to make oral health care more accessible for people living mental illness. Recommendations are to be made to community based mental health organization to aid the improvements in oral health with this group of people, thus building collaborative approach to support oral health care to this vulnerable group.

    It should be integrated and inclusive where Oral health experts along with psychiatrist, psychologist and therapist should be trained in basic regards to identify problems of each other providing referral.

    Bibek Prasain

    Dental Student BPKIHS



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