Integration of Oral Health and Mental Health into Primary Care

Oral Health

Boy brushing his teeth

Dental health is an essential part of healthy living.  According to the CDC, oral diseases like cavities and oral cancer cause pain and disability for millions of Americans each year. 1 Dental health is a reflection of lifestyle habits, as well as genetic factors. Dental health conditions like periodontal disease are “multifactoral”; resulting from both controllable and uncontrollable factors. 2 With the right combination of healthy lifestyle behaviors, people can decrease their risks for oral health problems.

Health Implications

Oral health conditions have been linked with increased risk for other serious health conditions.   For example:

  • American adults with tooth loss report being significantly more likely than those without tooth loss to have heart disease3
  • Heart disease prevalence increased with extent of tooth loss3
  • People with gum disease are almost twice as likely to suffer from coronary artery disease4
  • Several studies suggest a relationship between periodontal disease and stroke4

Risk Factors

Common risk factors for oral diseases are preventable as they relate to lifestyles, such as dietary habits, use of tobacco and excessive consumption of alcohol, and the standard of hygiene.When people have other health conditions like diabetes they have a much higher risk of developing oral health diseases. Good oral health is an important part of an overall healthy lifestyle and to preventing additional health complications.

Access to Care

Medicaid does not provide coverage for dental care for adults in Delaware. Adults with Medicaid or those without insurance can acquire dental care by paying out- of- pocket costs or by visiting free dental care clinics. Several of the free clinics in Delaware have waiting lists to receive services.

Dental Hygiene in Delaware

In 2008, 67.7% of adults who reported having a disability reported visiting their dentist within the last 12 months compared to 76.2% of adults who did not report having a disability. In addition, 27.2% of adults who reported having a disability indicated that it had been longer than one year since they had been to their dentist for a teeth cleaning compared to 22.3% of adults who did not report having a disability.6

Dental Care
Variable Categories Without a Disability With a Disability Total Delaware Population
Any visit to dentist in last 12 months Yes 76.2% 67.7% 74.4%
No 23.8% 32.3% 25.6%
Teeth cleaning in last 12 months Yes 77.7% 72.8% 76.7%
No 22.3% 27.2% 23.3%


This document provides a comprehensive list of dental clinics provided by the Delaware Division of Public Health.  The  list provides details about the clinic including location and hours, costs for services, and the insurance forms that they accept.  Many of the clinics offer free or low-cost services. Click here to download a pdf copy of this resource.

Mental Health/Emotional Well-being

All people, regardless of their abilities, have feelings and emotions. Maintaining good emotional well-being is fundamental to feeling good about yourself, and maintaining overall good health. Good mental health can be threatened by many factors:  your environment, biology, and how well you cope when faced with life’s challenging situations.

There are disparities for people with disabilities with respect to emotional support, life satisfaction and poor mental health frequency. According to the Delaware Behavioral Risk Factor Surveillance System (BRFSS), 2010, 8% of people with a disability (PWD) rarely/never have emotional support. It was found that 4.8% people without a disability rarely/never have emotional support. PWD 15.2% sometimes have emotional support compared to 8% of people without a disability who sometimes have emotional support. Lastly, 76.8% of PWD always/usually have emotional support versus 87.2% of people without a disability who always/usually have emotional support.

With respect to life satisfaction, 14.8% of people with a disability were very dissatisfied/dissatisfied compared to 2.7% of individuals without a disability who reported dissatisfaction. Lastly, respondents were asked about their mental health: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” A higher percentage of people with a disability reported their mental health not good for 30 days.

Understanding the warning signs of poor mental health is essential to preventing a serious threat to your emotional well-being. Poor mental health can lead to serious mental illnesses such as depressive and anxiety disorders, if not recognized and treated.  The good news is that most mental illnesses are treatable. For most people, effective treatment may consist of talk therapy with a mental health professional and/or medications. The following is a list of national and local resources that provide extensive information on mental health promotion and mental illness prevention.

Find mental health services in your area


National Resources
Mental Health America (MHA):

Mental Health America (formerly known as the National Mental Health Association) is the country’s leading non-profit dedicated to helping all people live mentally healthier lives.  MHA provides mental health information to the public, access to mental health support and services, and advocates for mental health issues on the local, state, and national level.

National Alliance on Mental Illness (NAMI)
The National Alliance on Mental Illness is the nation’s largest grassroots organization for people with mental illness and their families. NAMI members and friends provide support, education, and advocacy for mental illness.

National Institute of Mental Health (NIMH)
NIMH is the largest scientific organization in the world dedicated to research focused on the understanding, treatment, and prevention of mental disorders and the promotion of mental health.

National Suicide Prevention Lifeline
1-800-237-TALK or
A 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis.

Substance Abuse & Mental Health Services Administration (SAMHSA)
The Substance Abuse and Mental Health Services Administration (SAMHSA) focuses on building resilience and facilitating recovery for people with or at risk for mental or substance use disorders.

Delaware Resources

Division of Substance Abuse and Mental Health (DSAMH)
DSAMH operates the Delaware Psychiatric Center, Delaware’s only state-operated psychiatric hospital for adults. The Division also provides community support services to adults with psychiatric disabilities through two state-operated community mental health centers (CMHCs), New Castle County CMHC and Kent/Sussex CMHC, and through contracts with private agencies. These services include continuous treatment teams, group homes, and clinic-based services. The CMHCs also provide mental health counseling services and 24-hour mobile crisis intervention services statewide at 1.800.652.2929 in New Castle County and 1.800.345.6785 in Kent & Sussex Counties.

Mental Health Association in Delaware (MHA)
MHA provides information and referral for individuals wanting to access mental health treatment in Delaware, free literature on mental health topics, and free support groups statewide for people experiencing depression, anxiety, and loss from a suicide.

National Alliance for Mental Illness in Delaware (NAMI DE)
NAMI DE is a statewide organization of families, mental healthconsumers, friends, and professionals dedicated to improving the quality of life for those affected by life-changing brain diseases such as schizophrenia, bipolar disorder, and major depression.  NAMI provides housing, support groups for family members, and free literature on mental illnesses.

New Directions, Inc.
New Directions, Inc. provides support groups for people with depression and bipolar disorder (manic depression) and for their families and friends.  New Directions offers support meetings twice a month (on the second and third Monday) and educational meetings once a month (on the fourth Monday), as well as a major speaker once a year.