Sir, we read the letter Mental health disorders with interest.1 The authors made two important points on which we could not agree more: patients with mental disorders are becoming more common in daily dental practice, and as dentists we should enhance our role to manage them empathically. Since this topic is our research concern, here are some additional opinions that we would like to discuss.

All clinical practice guidelines in dentistry address the necessity of a systemic evaluation (eg medical history, medication) in parallel with a comprehensive examination of the oral cavity, to assess oral health and overall health. However, when it comes to systemic diseases dentists tend to focus more on physical conditions like cardiovascular or infectious diseases, that could pose a risk directly to routine dental procedures. Mental health or psychiatric history has thus never been a serious concern, even though oral symptoms can be a presentation of a mental condition.

We suggest using the concept of medically unexplained oral symptoms to explain in this circumstance. Indeed, the patients who failed in coping with their distress might experience their psychological symptoms in a physical form in the oral facial region.2 This is similar to our observation in 606 cases of oral dysaesthesias, in which it is concluded that dental treatment during the acute phase of depression could provoke an oral cenestopathy symptom.3 However, regardless of with or without psychiatric comorbidity, half of the patients with idiopathic oral pain (atypical odontalgia) still have their symptoms triggered by dental treatment.4 This suggests an appropriate assessment of mental health before a dental procedure could help eliminate, but maybe not completely, the risk of developing various somatic symptoms, especially in patients with acute depression.

There is no doubt that treating a patient with psychological problems is always difficult and challenging for any dentist, especially when they are not equipped with enough knowledge to recognise and avoid unnecessary risk. Hence, we believe that adding mental-health-related subjects into the dental curriculum is vital, even just at a level of 'psychiatry education for dental practice'.