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Independent pharmacists are ideally placed to help patients maintain good oral hygiene. Steve Titmarsh explains…

Each year on March 20, World Oral Health Day reminds the public that oral health and mental wellbeing are closely linked. If people don’t take good care of their teeth and gums, they not only increase their risk of tooth decay and gum disease, but they can also affect their mental health.

Untreated dental problems can exacerbate mental health conditions by contributing to chronic pain, reducing self-esteem and leading to less social interaction.

Poor mental health can have a significant impact on oral health too. Research shows that people experiencing mental health conditions such as depression, schizophrenia and anxiety face a greater risk of tooth decay, gum disease and tooth loss.

This can be due to a number of reasons, including poor oral hygiene, the side-effects of medicines, lifestyle factors and avoiding regular visits to the dentist. People with mental health problems or learning disabilities also have poorer access to dental health services.

According to experts on the British Dental Association (BDA)’s England Community Dental Services Committee (ECDSC), community pharmacies may be the initial point of contact for many vulnerable patients.

“Community pharmacists can play a vital role in supporting individuals with poor mental health through educating, informing and empowering people to take care of their oral health,” says the ECDSC.

“Alongside providing expert advice, community pharmacists can reinforce the messaging on the importance of maintaining an oral hygiene routine and visiting their dentist.”

Mental health conditions

According to the ECDSC, understanding the influence that mental health can have on the teeth and gums is essential to improve access to treatment.

“Individuals with depression may limit oral health-promoting behaviours, such as adhering to an optimal oral hygiene routine, and may adopt more detrimental behaviours, such as smoking,” say the committee members.

“There may be changes in appetite due to depression, such as an increase in sugary or acidic foods, which can have a negative impact on dental health and increase the risk of tooth decay.

“Alongside these issues, individuals with depression may be unable to keep dental appointments and/or may experience dental anxiety.”

Ingrid Perry MBE, oral health prevention lead at Mydentist, highlights that the side effects of some medicines for mental health conditions – such as antidepressants – can affect oral health.

“Dry mouth is one of the most common examples of this,” she says. “Saliva is essential for washing away food particles and neutralising harmful acids, so reduced saliva production increases the risk of tooth decay.”

Karen Coates, a registered dental nurse, oral health educator and spokesperson for the Oral Health Foundation (OHF), says that eating disorders are particularly harmful, especially if someone is vomiting regularly.

“The acid from vomit stays in the mouth and demineralizes enamel,” she says. “People are often tempted to brush their teeth straight after vomiting to remove the taste, but they shouldn’t brush their teeth for an hour or more, due to the acidity. Using a good fluoride mouthrinse is better for their teeth.”

Dental phobia

According to a survey carried out by Dental Phobia, up to 53 per cent of the UK population suffer from fear or anxiety when visiting the dentist, with 17 per cent of the population refusing to visit or to have essential dental work.

Karen Coates says that if someone hasn’t been to a dentist for a long time, they may build up the experience in their mind. “It can help to break down their fears into smaller pieces,” she says.

“No matter how bad they think their mouth is, it won’t be the worst their dentist has seen. They could start by going into the dental surgery, asking for a brochure and speaking to the receptionist. If they mention dental phobia, they should be directed to the most appropriate dentist. They could then sit in the chair for a while to get used to it.”

Dental teams can use a range of techniques to support patients with dental phobia. These include using a quiet waiting area to limit sound transmission from the dental surgery, arranging longer appointments to address patient’s concerns, treatment staging and cognitive behavioural therapy.

How big a factor is dental phobia in poor oral health? 

Miranda Pascucci, the head of clinical education and dental therapist at TePe, said women are more likely to “experience dental anxiety” than men and it “generally decreases with age”.

“Dental anxiety can stem from past negative experiences, especially during childhood,” she said. “The fear of pain or the feeling of not being in control during dental visits can also make things worse. To overcome dental anxiety, good communication is key.

“Community pharmacists can help by reassuring patients about the importance of visiting the dentist, offering advice on how to stay calm during appointments, and suggesting techniques such as deep breathing or meditation.

“In some cases, cognitive behavioural therapy may also be beneficial in reframing negative associations with dental care.

“By speaking positively about the benefits of seeing dental professionals and recommending simple coping strategies, pharmacists can play an important role in helping to reduce patient fears.”                           

Learning disabilities or difficulties

A government report on “Oral care and people with learning disabilities”, updated in April 2025, revealed that people with learning disabilities have poorer oral health and more problems accessing dental services than people in the general population, due to cognitive, physical and behavioural factors. They may be reliant on their carers and/or paid supporters for oral care and initiating dental visits.

Alwyn Fortune, community pharmacist and policy and engagement lead at RPS Wales, says that it can help to give patients with learning difficulties more time to process information, using formats they understand or prefer, and the opportunity to ask questions without feeling rushed.

“Pharmacists should use simple language, visual aids and repeat information to ensure patients feel empowered when making decisions,” he says.

“They can encourage preventative dental care, signpost to dental services, and use their trusted role to reduce fear or misconceptions about dental visits.”

The ECDSC says that community pharmacists can encourage proactive habits, such as regular brushing with fluoride toothpaste. “Their regular contact with the community, particularly with carers and support workers, puts them in a strong position to reinforce oral health messages,” says the committee members.

Neurodivergence

According to Alwyn Fortune, neurodivergent adults, including those with autism or ADHD, may experience challenges with oral health due to sensory sensitivities, making brushing, flossing or using mouthwash distressing.

“They may also struggle with organising appointments, hygiene routines or using the fine-motor skills needed for brushing,” he says. “Pharmacists can support by offering private or extended consultations, using plain language and visual aids, and liaising with family members or carers where needed.”

Karen Coates says it’s important to address neurodivergent customers’ needs individually. “Some neurodivergent people are overstimulated by lights and sounds, whereas others aren’t affected,” she says.

“Encourage them to write down what they do and don’t like and show this to a dentist. Then they can work out how to overcome any issues with dental appointments – such as wearing dark glasses or headphones.

“Pharmacies can stock a range of products to help, such as toothpastes that don’t foam up or taste strongly of mint, and milder flavoured mouthwashes.”