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Anxiety, Depression, Stress, and Oral Health
Identification of At-risk Patients in the Dental Surgery: Screening and Referral

Course Author(s): Maria L. Geisinger, DDS, MS

Identification of At-risk Patients in the Dental Surgery: Screening and Referral

A readily available screening tool that allows dentists to assess level of depression is critical to identify the high number of individuals with undiagnosed mental disorders. A recent investigation demonstrated that dentists can effectively evaluate patients to identify both undiagnosed and undertreated depression with an eight question survey instrument, the Patient Health Questionnaire Depression Scale (PHQ8) (Figure 4).78,79 This may allow for dental healthcare practitioners to evaluate levels of depression in their patients and to refer patients to appropriate medical healthcare professionals. Furthermore, education and resources should be provided for individuals who are treating patients with diagnosed anxiety and depression so that they can discuss the oral implications of these diseases and the medications used to treat the diseases with patients to allow for continued monitoring and treatment of patients’ oral health.

Figure 4. A Simplified Screening Tool for Depression/Anxiety.80
Simplified Screening Tool for Depression/Anxiety

Personal Health Questionnaire
Depression Scale (PHQ-8)

Over the last two weeks, how often have you been bothered by any of the following problems? (circle one number on each line)

How often during the past 2 weeks were you bothered by…

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
  • Little interest or pleasure in doing things
  • Feeling down, depressed, or hopeless
  • Trouble falling or staying asleep, or sleeping too much
  • Feeling tired or having little energy
  • Poor appetite or overeating
  • Feeling bad about yourself, or that you are a failure, or have let yourself or your family down
  • Trouble concentrating on things, such as reading the newspaper or watching television
  • Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual

Scoring

If two consecutive numbers are circled, score the higher (more distress) number. If the numbers are not consecutive, do not score the item. Score is the sum of the 8 items. If more than 1 item missing, set the value of the scale to missing. A score of 10 or greater is considered major depression, 20 or more is severe major depression.

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