Oral health of adults with serious mental illnesses: a review

Severe odontogenic infections in patients with mental disorders: the challenge of ineffective initial treatment

OBJECTIVES

This study clarified possible delays and deficiencies in severe odontogenic infection (OI) treatment in patients with mental disorders.

STUDY DESIGN

Data of hospitalized patients with severe OI were evaluated retrospectively. The outcome variable was preceding health care visits prior to hospitalization. The primary predictor was patient's mental disorder. Explanatory variables were age, sex, smoking, heavy alcohol use, immunocompromised disease or medication, and time span from beginning of symptoms to hospitalization. Also, factors leading to intensive care unit (ICU) care were evaluated.

RESULTS

Preceding visits prior to hospitalization were found in 61 (35.5%) out of 172 patients with OI. In total, 27 patients (15.7%) had a current mental disorder, more commonly in women (26.0%) than in men (8.1%) (P = .001). Patients with mental disorders had preceding health care visits related to the current infection notably more often than patients without recent psychiatric history (51.9% vs. 32.4%), P = .053. Patient-related treatment delay remained nonsignificant. Heavy alcohol use (P = .010) and smoking (P = .025) predicted ICU treatment, but no association with patient's mental disorder was found.

CONCLUSIONS

A patient's mental disorder can complicate diagnosis of OI. Effective and timely treatment requires the professional's ability to simultaneously identify the patient's mental health challenges and progressing OI.

Mental and Oral Health: A Dual Frontier in Healthcare Integration and Prevention

Mental and oral health are interrelated, and problems in one area usually affect the other. This review discusses the complex relationships between oral and mental health, particularly the psychosocial challenges faced by individuals with mental health disorders in maintaining oral hygiene, including stigma, lack of access to care, and financial barriers. It also discusses how psychiatric conditions influence oral health, with regard to issues such as dry mouth, gum disease, and tooth decay, and how poor oral health can aggravate mental well-being. Preventive measures, treatment approaches, and solutions to overcome these barriers are also discussed. Methodological rigor was achieved by systematically searching high-impact journals indexed in PubMed and Google Scholar for peer-reviewed publications published between 2000 and 2024. High-impact journals have a high impact factor and rigorous peer-review standards. Articles that did not undergo peer review, articles published in languages other than English, or those that were not accessible (because access was closed unless key information was available through abstracts or summaries) were excluded. It mentions the relevance of integrating mental health services with oral health services, with a focus on individualized care, interdisciplinary cooperation, and creative strategies to break down systemic barriers, resulting in better health outcomes and lower healthcare costs.

Exploring the Link between Xerostomia and Oral Health in Mental Illness: Insights from Autism Spectrum Disorder, Depression, Bipolar Disorder, and Schizophrenia

BACKGROUND

The relationship between mental disorders and oral health is complex, involving behavioral, biological, and psychosocial factors. This review aims to investigate the impact of mental disorders, including autism spectrum disorder (ASD), depression, bipolar disorder, and schizophrenia, on oral health outcomes.

METHODS

A comprehensive review of existing literature was conducted to analyze the oral health outcomes associated with each mental disorder. The focus was on examining dietary habits, oral hygiene behaviors, physiological changes, and medication side effects that contribute to oral health issues.

RESULTS

The findings indicate that individuals with ASD often exhibit unique dietary habits and reduced oral hygiene capabilities due to sensory sensitivities, leading to a higher prevalence of dental caries and periodontal diseases. Depression and bipolar disorder are associated with physiological changes such as reduced saliva production and poor oral hygiene behaviors, increasing the risk of oral health problems. Medications used for these conditions exacerbate issues like xerostomia, further elevating the risk of dental diseases. Schizophrenia poses additional challenges, including cognitive impairments and medication side effects that hinder effective oral care, heightening susceptibility to oral diseases.

CONCLUSIONS

This review highlights the specific oral health challenges associated with different mental disorders and emphasizes the need for tailored dental care strategies that integrate mental health considerations. The study contributes to the literature by demonstrating the unique oral health impacts of these disorders. However, the findings are limited by the scope of available cross-sectional data and the absence of longitudinal studies. Future research should focus on longitudinal and intervention-based studies to explore causal relationships and develop effective treatments.

Oral Health Recovery: Randomized Evaluation of an Oral-Behavioral Health Integration Approach

INTRODUCTION

This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists ("peers")-lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others.

METHODS

Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators.

RESULTS

More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained.

CONCLUSIONS

Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.

Effectiveness of oral health interventions among children and adolescents with mental disorders: a systematic review

BACKGROUND

The rising percentage of children and adolescents experiencing mental disorders brought attention to the emerging opportunities for proactive oral health interventions in this population. Currently, existing guidelines focus mainly on oral health in general practice and on adults residing in care homes. This report aims to provide a broad overview of the effectiveness of oral health interventions for children and adolescents with mental disorders.

METHOD

This review followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses 2020) statement. The initial electronic search yielded a total of 3710 articles. The search identified 2354 potential papers after removing duplicates and 2301 articles were excluded by title and abstract. The full texts of the remaining 53 articles and nine articles from the citation searching were screened and 15 articles matched the inclusion criteria. The Mixed-Method Appraisal Tool (MMAT) was used for quality appraisal.

RESULTS

The thematic analysis resulted in four main themes which were educational intervention, physical intervention, clinical intervention, and a combination of both educational and clinical intervention.

CONCLUSION

We presented the findings in a narrative synthesis with the primary outcomes which served as answers to our main research question that prompted this systematic review.

The relationship between self-reported poor mental health and complete tooth loss among the US adult population in 2019

Objective

Very little is known about the association between poor mental health and poor oral health outcomes in the United Sates. This study investigated the prevalence of complete tooth loss among those with and without perceived poor mental health in a nationally representative sample of noninstitutionalized U.S. adults.

Methods

Using a cross-sectional study design, we analyzed the 2019 Medical Expenditures Panel Survey to determine the unweighted and weighted prevalence of complete tooth loss among adults. Chi-squared and multivariate logit regression with marginal effects were used to measure the association between complete tooth loss and perceived poor mental health, controlling for respondent characteristics.

Results

The prevalence of adults (ages 18 and older) experiencing complete tooth loss was 6% (95% CI: 5.6-6.4). Individuals who have perceived poor mental health were 1.90 percentage points (pps) more likely to report missing all their natural teeth (P = 0.006: 95% CI: 0.5-3.3). Other relevant predictors of complete tooth loss included current smoking status (5.9 pps; 95% CI: 4.5 to 7.2) and secondary education (-6.4 pps (95% CI: -7.0 to -4.8).

Conclusions

Overall, self-reported poor mental health was found to be associated with a greater likelihood of reporting complete tooth loss. Findings from this study underscore the need for greater integration of care delivery between behavioral health specialists and dental providers.

Oral health primary preventive interventions for individuals with serious mental illness in low- and middle-income nations: Scoping review

Mental health disorders constitute a major global disease burden, especially in low and middle-income countries (LMICs). Due to issues related to access, hygiene, economic pressures, and communication, the oral health of individuals with serious mental illness (SMI) receives little attention. This scoping review comprehensively maps and synthesises the existing literature on oral health primary preventive interventions (OHPPIs) in LMICs, highlighting key strategies and challenges encountered in addressing oral health disparities in resource-constrained settings. We systematically searched Cochrane Library, Ovid (MEDLINE), PsycINFO and Embase. The search strategy included keywords and MeSH terms related to oral health, SMI interventions, and LMICs. We included all types of OHPPI, (preventive, promotive, behavioural, and educational approaches) implemented in LMICs. We identified three studies focused on OHPPI for SMI patients that met our inclusion criteria. The interventions included were: (I) educational interventions; (II) behavioural interventions combining motivational and educational elements, and (III) self-assessment interventions combining educational and physical elements. Multifaceted barriers and challenges to effective oral health interventions were identified covering limited access to dental services, and socio-economic disparities. This scoping review underscores the need to develop and test context-specific strategies, capacity building, and policy support to improve oral health outcomes in LMICs.

The Relationship between Oral Health and Schizophrenia in Advanced Age-A Narrative Review in the Context of the Current Literature

Schizophrenia is a psychiatric disorder that makes patients incompetent to perform day-to-day activities due to their progressing mental illness. In addition to disturbances with thoughts, behavioral changes, and impaired cognitive functions, oro-systemic health also becomes compromised. Even though the population with schizophrenia is primarily made up of older people, little is known about this group's oral health treatment. The present review explores the relationship between oral healthcare and elderly patients with schizophrenia. Our literature search included databases, like PubMed, Embase, and Google Scholar, for appropriate and evidence-based information. Preventive and management strategies outlined in the included articles and future research perspectives in this field are discussed. To the best of our knowledge, this is the first review that looked at dental care and related characteristics in older schizophrenia patients. The findings highlight the necessity for targeted dental interventions to address the dental health challenges faced by this vulnerable population. Integrating dental health into the overall medical management of elderly individuals with schizophrenia is crucial. Although specific therapies remain limited, the emphasis is on preventive dentistry to reduce the occurrence and progression of oral diseases in this group.

Periodontal disease in people with a history of psychosis: Results from the UK biobank population-based study

OBJECTIVES

To test the hypotheses that: (1) Prevalence of periodontal disease would be higher in people with a history of psychosis when compared to the general population and (2) Demographic, life-style related factors and co-morbid medical conditions would predict periodontal disease in people experiencing psychosis.

METHODS

The authors performed cross-sectional analysis of baseline data from the UK Biobank study (2007-2010), identifying cases with psychosis using clinical diagnosis, antipsychotic medication, and self-report. Demographic (age, gender, ethnicity, socioeconomic status), lifestyle-related(BMI, blood pressure, smoking and alcohol intake, physical activity) and physical co-morbidities (cancer, cardiovascular, respiratory, inflammatory disease and metabolic conditions) were included as potential risk factors for periodontal disease among people with a history of psychosis using logistic regression analyses. The analysis sample included 502,505 participants.

RESULTS

Risk of periodontal disease was higher in people with psychosis, regardless of how cases were identified. Patients with a clinical diagnosis had the highest proportion of periodontal disease compared to the general population (21.3% vs. 14.8%, prevalence ratio 1.40, 95% CI: 1.26-1.56). Older and female cases were more likely to experience periodontal disease. Lifestyle factors (smoking) and comorbidities (cardiovascular, cancer or respiratory disease) were associated with periodontal disease among people with a history of psychosis.

CONCLUSIONS

The findings suggest that periodontal disease is more common in people with a history of psychosis, compared to the general population. Prevention and early diagnosis of periodontal disease should be a priority for oral health promotion programmes, which should also address modifiable risk factors like smoking which also contribute to co-morbid systemic disease.

Importance of oral health in mental health disorders: An updated review

Background

Mental disorders are indeed an expanding threat, which requires raised awareness, education, prevention, and treatment initiatives nationally and globally. This review presents an updated review on the relationships between oral health and mental health disorders and the importance of oral health in mental health disorders.

Method

A literature search was done regarding mental disorders and oral health approaches in Google Scholar and PubMed from the year 1995 until 2023. All the English-language papers were evaluated based on the inclusion criteria. Publications included original research papers, review articles and book chapters.

Results

Common mental disorders include depression, anxiety, bipolar disorder, Schizophrenia, dementia, and alcohol and drug use disorders. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others.

Conclusion

There is a complex relationship between mental disorders and oral diseases. Various oral health problems are associated with mental health problems. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others. Mental health nurses including physicians and dental professionals should be involved in the oral health care of mental health disorder patients. Therefore, multidisciplinary should be involved in the care of mental health disorders, and they should consider oral health care as an essential part of their care for patients with mental health disorders. Future investigations should strive to elucidate the exact biological relationships, to develop new directions for treatment.

Effect of Individualized Oral Health Care Training Provided to 6-16-Year-Old Psychiatric In-Patients-Randomized Controlled Study

BACKGROUND

To assess the effect of individualized oral health care training (IndOHCT) administered to 6-16-year-old psychiatric in-patients on dental plaque removal.

METHODS

74 in-patients with mental health disorders (49 males) aged 6-16 years with a mean age of 10.4 ± 2.3 years, were randomly divided into two equal groups. At the start of hospitalization, one calibrated dentist assessed the oral health status in the hospital setting. In-patients of the intervention group (IG) received IndOHCT, while those of the control group (CG) got an information flyer. Dental plaque was assessed by the Turesky modified Quigley-Hein-Index (TI) at the start (t0) and at the end of hospitalization before (t1a) and after (t1b) autonomous tooth brushing.

RESULTS

During hospitalisation, the TI was reduced in both groups (t0→t1a: IG = -0.1; CG = -0.2, p = 0.71). However, in-patients receiving IndOHCT achieved significantly higher plaque reduction rates than the controls when plaque values before and after autonomous tooth brushing were compared (t1a→t1b: IG = -1.0; CG = -0.8; p = 0.02). The effect size (ES) demonstrates the efficacy of IndOHCT (ES = 0.53), especially in children with mixed dentition (ES = 0.89).

CONCLUSIONS

IndOHCT enabled hospitalized children and adolescents with mental health disorders to achieve a better plaque reduction by tooth brushing but failed to improve self-controlled routine oral hygiene.

A Qualitative Study Exploring the Barriers and Facilitators for Maintaining Oral Health and Using Dental Service in People with Severe Mental Illness: Perspectives from Service Users and Service Providers

People with severe mental illness suffer from a high burden of oral diseases, which can negatively impact their physical and mental well-being. Despite the high burden, they are less likely to engage in oral health care including accessing dental services. We aimed to identify both the service users' and service providers' perspective on the barriers and facilitators for maintaining oral health and dental service use in people with severe mental illness. Qualitative exploration was undertaken using dyadic or one-to-one in-depth interviews with service users in the UK with a diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder. Service providers, including mental health and dental health professionals, and informal carers (people identified as family or friend who are not paid carers) were also interviewed. Thematic analysis of the data revealed three main cross-cutting themes at the personal, inter-personal and systems level: amelioration of the problem, using a tailored approach and provision of comprehensive support. The main barriers identified were impact of mental ill-health, lack of patient involvement and tailored approach, and accessibility and availability of dental services including lack of integration of services. The main facilitators identified were service providers' effective communication skills and further support through the involvement of carers. The findings suggest that the integration of dental and mental health services to provide tailored support for overall health and well-being, including the oral health of the patient, can better support people with severe mental illness regarding their oral health needs.

Association of childhood maltreatment history with salivary interleukin-6 diurnal patterns and C-reactive protein in healthy adults

Childhood maltreatment has been associated with increased inflammation, as indicated by elevated levels of proinflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP). Studies in humans show that secretion of IL-6 follows a clear circadian rhythm, implying that its disturbed rhythm represents an important aspect of dysregulated inflammatory system. However, possible alterations in diurnal secretion patterns of IL-6 associated with childhood maltreatment have not been studied. Here we investigated this association in 116 healthy adults. Diurnal levels of IL-6 were examined using saliva samples collected at 5 times a day across 2 consecutive days. Salivary CRP levels were also determined by averaging measurements at 2 times a day for 2 days. Different types of childhood maltreatment were assessed with the Childhood Trauma Questionnaire (CTQ). CTQ total and emotional abuse scores were significantly correlated with smaller IL-6 diurnal variation as indexed by lower standard deviation across the measurement times (p = 0.024 and p = 0.008, respectively). Individuals with emotional abuse, as defined by a cut-off score of CTQ, showed flatter IL-6 rhythm than those without (p = 0.031). These results, both correlation and group comparison, remained significant after controlling for age, sex, and body mass index. Childhood maltreatment was not associated with total output of IL-6 or CRP. Our findings indicate that childhood trauma can have a long-term negative effect on the circadian rhythm of inflammatory system. The findings are consistent with those of previous studies on adulthood trauma, suggesting that the disrupted IL-6 rhythmicity may be associated with a broad range of trauma-related conditions.

Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis

AIM

To understand the relationship between serious mental illness and oral health self-care behaviours using meta-analytic methods and a narrative synthesis of available literature.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines [PROSPERO reference: CRD42020176779]. Search terms pertaining to serious mental illness and oral health were entered into EMBASE, PsycINFO, Medline and CINAHL. Eligible studies included a sample of people with a serious mental illness and a quantitative measure of an oral health self-care behaviour (eg dental visits, toothbrushing). The Effective Public Health Practice Project tool was utilised to appraise the quality of the literature. Studies in the meta-analysis contained a non-clinical or general population comparator sample.

RESULTS

People with a serious mental illness were significantly less likely to visit the dentist (OR 0.46, 95% CI 0.32-0.065, p > 0.001) or brush their teeth (OR 0.19, 95% CI 0.08-0.42, p < 0.001) when compared to non-clinical comparator samples. Few studies explored other oral health self-care behaviours (eg flossing and mouth washing), but uptake was generally low in people with a serious mental illness. The study quality of included studies was variable.

CONCLUSIONS

The research showed a reduced uptake of oral health self-care behaviours in people with a serious mental illness. Suboptimal oral health can negatively impact on physical, social and psychological functioning. Further research is needed to understand the reasons for low rates of oral health self-care behaviours in this population.

Poor Oral Health in Patients with Schizophrenia: a Meta-Analysis of Case-Control Studies

Patients with schizophrenia have high rates of comorbid physical illness, but there has been less attention to dental diseases in these patients. This meta-analysis of case-control studies systematically examined the oral health in patients with schizophrenia. Case-control studies comparing the oral health in patients with schizophrenia and healthy controls were screened and identified. Standardized mean difference (SMD) with its 95% confidence interval (CI) was calculated using RevMan version 5.3. Three case-control studies comprising 306 patients with schizophrenia and 306 healthy controls were included in this meta-analysis. All studies were rated as "high quality". Patients with schizophrenia had significantly higher scores of decayed, missing and filled teeth (SMD = 0.83, 95%CI: 0.57, 1.09, p < 0.001; I² = 51%), missing teeth (SMD = 0.79, 95%CI: 0.59, 0.98, p < 0.001; I² = 19%), and decayed teeth (SMD = 0.89, 95%CI: 0.24, 1.54, p = 0.008; I² = 92%) when compared to healthy controls. Similarly, patients with schizophrenia had significantly lower filled teeth scores (SMD = -0.76, 95%CI: -1.44, -0.09, p = 0.03; I² = 93%) when compared to healthy controls. This meta-analysis found that patients with schizophrenia were likely to have worse oral health when compared to healthy controls.

Barriers to and Facilitators of Oral Health Among Persons Living With Mental Illness: A Qualitative Study

OBJECTIVE

Persons with mental illness have poorer oral health and are less likely to receive oral health care than those in the general population. A comprehensive understanding of barriers to and facilitators of accessing oral health care from a multidisciplinary perspective is lacking. The authors of this qualitative study sought to explore barriers and facilitators in addressing the oral health needs of individuals with mental illness from the perspectives of patients, psychiatrists, and dentists.

METHODS

A thematic content analysis approach was used to triangulate the perspectives of the three groups. Face-to-face semistructured interviews were conducted in 2018-2019 with patients with mental illness (N=20), psychiatrists (N=20), and dentists (N=25) at an academic medical campus in rural eastern North Carolina. Participants were recruited until thematic saturation for each group was reached.

RESULTS

Reported barriers to oral health care were categorized under emerging themes: access to dental care, fear of dental care, characteristics of mental illness, lack of oral health screening by psychiatrists, lack of education and training, stigma of mental illness, and lack of communication. Facilitators of oral health care were linked to the reported need for education and training, financial support, dentists' chairside manner, community support, and interprofessional communication.

CONCLUSIONS

The findings highlight health system gaps between oral health and mental health. The barriers and facilitators identified can help inform the development of interventions to improve oral health of patients with mental illness. Interventions should include interdisciplinary education and training, improved communication, and strategies to reduce financial barriers and anxiety in dental practice.

Measuring salivary markers of inflammation in health research: A review of methodological considerations and best practices

There is an increasing interest in using saliva to measure inflammatory biomarkers. Compared to blood, saliva is non-invasive, requires a lower biosafety classification, and requires less specialized personnel to collect. As the assessment of inflammation in saliva becomes more popular in psychoneuroimmunology research, the development of gold-standard methodological practices is paramount. This paper reviews different considerations for designing studies to assess salivary measures of inflammation. We review saliva collection procedures, sample storage and processing considerations, assay techniques, flow rate, correspondence with blood-based markers, and potential demographic and health moderators of levels of salivary markers of inflammation. Together, this review highlights critical gaps for future research, including calls for standardization of study protocols, transparent reporting of results, assessing predictive validity of markers of salivary inflammation for disease, and the need for assessment of participants' oral and general health status. Although additional work is needed to elucidate gold standards for study design, measurement, and analysis, salivary markers of inflammation may be a useful tool for understanding oral and peripheral inflammation dynamics non-invasively.

Dental visits in Medicaid-enrolled youth with mental illness: an analysis of administrative claims data

Background

State Medicaid plans across the United States provide dental insurance coverage to millions of young persons with mental illness (MI), including those with attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, and schizophrenia. There are significant oral health challenges associated with MI, and providing dental care to persons with MI while they are young provides a foundation for future oral health. However, little is known about the factors associated with the receipt of dental care in young Medicaid enrollees with MI. We aimed to identify mental and physical health and sociodemographic characteristics associated with dental visits among this population.

Methods

We retrospectively analyzed administrative claims data from a Medicaid specialty health plan (September 2014 to December 2015). All enrollees in the plan had MI and were ≥ 7 years of age; data for enrollees aged 7 to 20 years were analyzed. We used two-level, mixed effects regression models to explore the relationships between enrollee characteristics and dental visits during 2015.

Results

Of 6564 Medicaid-enrolled youth with MI, 29.0% (95% CI, 27.9, 30.1%) had one or more visits with a dentist or dental hygienist. Within youth with MI, neither anxiety (Adjusted odds ratio [AOR] = 1.15, p = 0.111), post-traumatic stress disorder (AOR = 1.31, p = 0.075), depression (AOR = 1.02, p = 0.831), bipolar disorder (AOR = 0.97, p = 0.759), nor schizophrenia (AOR = 0.83, p = 0.199) was associated with dental visits in adjusted analyses, although having ADHD was significantly associated with higher odds of dental visits relative to not having this condition (AOR = 1.34, p < 0.001). Age, sex, race/ethnicity, language, and education were also significantly associated with visits (p < 0.05 for all).

Conclusions

Dental utilization as measured by annual dental visits was lower in Medicaid-enrolled youth with MI relative to the general population of Medicaid-enrolled youth. However, utilization varied within the population of Medicaid-enrolled youth with MI, and we identified a number of characteristics significantly associated with the receipt of dental services. By identifying these variations in dental service use this study facilitates the development of targeted strategies to increase the use of dental care in – and consequently improve the current and long-term wellbeing of – the vulnerable population of Medicaid-enrolled youth with MI.

Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections

Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p < 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.

Dentists' perspectives on barriers to providing oral health care in French psychiatric hospitals with on-site dental clinics

OBJECTIVES

Psychiatric inpatients suffer from poorer oral health than the general population, and difficulties in accessing necessary dental treatment remain even when a dedicated dental service is available within the psychiatric hospital. The aim of this study was to identify barriers to access dental care from the point of view of dentists working within French psychiatric hospitals.

METHODS

The relatively small number of dentists working in psychiatric hospitals necessitated a qualitative approach. Semi-structured interviews were conducted, recorded, transcribed and coded in a conventional content analysis approach.

RESULTS

Eight interviews were conducted. Six of the dentists interviewed were men, and two were women. Three of them worked full-time in a psychiatric facility, while the other five worked partly in the hospital and partly in private practice. The average duration for interviews was 54 minutes (minimum 24 min, maximum 89 min). The interviews highlighted three dimensions of barriers to access to dental care. The first dimension was directly related to the patient. This may be linked to the patient's psychiatric disorder but not necessarily. This also encompasses refusal of care. A second dimension regrouped events related to the organization of the hospital (locally), such as communication issues between staff members within the dental office, and with other staff members from the psychiatric ward. A third dimension included difficulties related to the overall organization of the healthcare system, including financial issues and deinstitutionalization.

CONCLUSIONS

In-site dental consultations appear as an interesting tool to enhance access to oral care for psychiatric inpatients. However, difficulties remain from the dentists' perspective.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

BACKGROUND

The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care.

METHODS

The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.

DISCUSSION

This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness

OBJECTIVE

The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups.

METHODS

Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care.

RESULTS

More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points.

CONCLUSIONS

Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.

Mental Disabilities Increase the Risk of Respiratory Infection-related Healthcare Utilization

Patients with chronic mental illness are highly vulnerable to chronic respiratory problems. We examined the influence of mental disability on respiratory infection-related utilization risk in individuals with and without mental disabilities (MDs). A population-based, retrospective cohort design and two-part model were used to analyze respiratory infection-related utilization in individuals with MDs (MD group) and a matched reference group. The respiratory infection-related utilization rate in one year was lower in the MD group (53.8%) than in the reference group (56.6%). The odds ratios (ORs) were significantly higher among individuals with profound MDs (aOR = 1.10; 95% CI: 1.07–1.14) and those with a history of dental cavities (aOR = 1.16; 95% CI: 1.13–1.19) or periodontal disease (aOR = 1.22; 95% CI: 1.19–1.26) after controlling for covariables. The average number of visits was higher in the MD group (5.3) than in the reference group (4.0). The respiratory infection-related utilization rate and average number of visits were significantly higher in the mild, moderate and severe disabled groups with a history of periodontal disease, respectively, than that of the reference group. In conclusion, healthcare authorities must develop an incentive program to prevent respiratory infections among individuals with MDs.

The role of community mental health services in supporting oral health outcomes among consumers

People with a lived experience of mental illness are at a higher risk for developing oral diseases and having poorer oral health than the broader population. This paper explores the role of Australian community mental health services in supporting the prevention and management of poor oral health among people living with mental illness. Through focus groups and semi-structured interviews, participants identified the value of receiving oral health support within a community mental health setting, in particular the delivery of basic education, preventive strategies, assistance with making or attending appointments and obtaining priority access to oral health services. Engagement with Community Health Services and referrals generated through the priority access system were identified as key enablers to addressing oral health issues. This study provides new insight into the importance of undertaking an integrated approach to reducing the oral health disparities experienced by those living with mental illness.

Acute general hospital admissions in people with serious mental illness

BACKGROUND

Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area.

METHODS

Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data.

RESULTS

Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific ('Z-code') causes. The five commonest specific ICD-10 diagnoses at discharge were 'chronic renal failure' (N18), a non-specific code (Z04), 'dental caries' (K02), 'other disorders of the urinary system' (N39), and 'pain in throat and chest' (R07), all of which were higher than expected (SARs ranging 1.57-6.66).

CONCLUSION

A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.

Poor oral health in patients with schizophrenia: A systematic review and meta-analysis

Increased rates of comorbid physical illness have been commonly reported in patients with schizophrenia. However, there are fewer data on dental disease in these patients. We systematically evaluated existing data on the oral health survey of schizophrenia patients through meta-analysis. Using the available databases, we performed a systematic search to identify the studies examining the oral health in schizophrenia patients from January 1997 to June 2017, based on the inclusion and exclusion criteria. Two investigators extracted the related data independently. The meta-analysis was performed by using the RevMan 5.3 software after data extraction and quality assessment. We compared the oral health results between the schizophrenia patients and the general population, including the following measures: the mean number of decayed, missing and filled teeth (DMFT). Eight studies comprising 2640 patients with schizophrenia and 19,698 healthy controls were included in the meta-analysis. The patients with schizophrenia had significantly higher scores of dental caries (mean difference [MD] = 7.77, 95% confidence interval [CI] = 3.27 to 12.27), missing teeth (MD = 7.61, 95% CI = 3.44 to 11.77), and decayed teeth (MD = 3.44, 95% CI = 2.06 to 4.82) compared to controls (all p < 0.01). By contrast, the schizophrenia patients had fewer score of filled teeth (MD = -3.06, 95% CI, -4.82 to -1.30) than the controls (p < 0.01), indicating decreased access to dental care. Our systematic review suggests that patients with schizophrenia have worse oral health than the general population, but have received less dental care services. Hence, the oral health services should be taken into account in the patients with schizophrenia.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness

INTRODUCTION

Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes.

METHODS

Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes).

RESULTS

Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed.

CONCLUSIONS

Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.

The oral health of long-term psychiatric inpatients in Singapore

This cross-sectional study aims to describe the dental caries experience, treatment needs, and experience of dry mouth of 191 long-term psychiatric inpatients in Singapore. Medical history, dental caries experience [represented by the Decayed Missing or Filled Teeth index (DMFT)], salivary flow, and treatment needs were recorded. Information on brushing, pain (when eating), and xerostomia was gathered. Bivariate analysis was used to examine the associations of DMFT, saliva flow, the presence of salivary gland hypofunction (SGH), and xerostomia. Simple linear regression was used to examine the association between SGH and DMFT. The sample comprised 143 men (74.9%) and 48 women (25.1%), aged 24 to 80 years old. 169 patients (88.5%) had schizophrenia. DMFT ranged from 0 to 32, with a mean of 21.6 (SD 9.7). Mean DMFT scores were significantly higher among males and older patients. 77 of 176 patients (43.8%) were found to have SGH. SGH was associated with a higher mean DMFT. Those taking classical antipsychotics and anticholinergics had significantly lower mean saliva flow and tended to have SGH. 107 of 165 patients (64.8%) were found to experience xerostomia. Long-term psychiatric inpatients in Singapore have poor oral health, unmet treatment needs, and suffer from dry mouth.

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services

A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.

Eating Behaviors and Related Factors in Psychiatric Patients

The aim of this study was to determine the risk of eating disorders and associated risk factors in individuals with psychiatric disorders. Patients who were hospitalized in a psychiatry clinic of the university hospital between the dates of February 2014 and July 2014 constitute sample for the study. The study sample consisted of a total of 216 patients. Data were collected using a questionnaire form and the Eating Attitude Test. The mean age of the patients was 37±0.5, and 56.9% of the patients were female. Problems in eating behavior were observed in 11.6% of the patients, and a statistically significant relationship was found between the risk of eating disorders and diagnosis, gender, exercise and self-perception of weight. The risk of eating disorders was more frequently observed in patients diagnosed with depression, in female patients with a self-perceived weight problem and do not exercise.

Enhancing oral health for better mental health: Exploring the views of mental health professionals

The association between oral health, self-esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants' ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes.

Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial

BACKGROUND

The British Society for Disability and Oral Health guidelines made recommendations for oral health care for people with mental health problems, including providing oral health advice, support, promotion and education. The effectiveness of interventions based on these guidelines on oral health-related outcomes in mental health service users is untested.

OBJECTIVE

To acquire basic data on the oral health of people with or at risk of serious mental illness. To determine the effects of an oral health checklist in routine clinical practice.

DESIGN

Clinician and service user-designed cluster randomised trial.

SETTINGS AND PARTICIPANTS

The trial compared a simple form for monitoring oral health care with standard care (no form) for outcomes relevant to service use and dental health behaviour for people with suspected psychosis in Mid and North England. Thirty-five teams were divided into two groups and recruited across 2012-3 with one year follow up.

RESULTS

18 intervention teams returned 882 baseline intervention forms and 274 outcome sheets one year later (31%). Control teams (n=17) returned 366 baseline forms. For the proportion for which data were available at one year we found no significant differences for any outcomes between those allocated to the initial monitoring checklist and people in the control group (Registered with dentist (p=0.44), routine check-up within last year (p=0.18), owning a toothbrush (p=0.99), cleaning teeth twice a day (p=0.68), requiring urgent dental treatment (p=0.11).

CONCLUSION

This trial provides no clear evidence that Care Co-ordinators (largely nursing staff) using an oral health checklist improves oral health behaviour or oral health state in those thought to be at risk of psychosis or with early psychosis.

Oral Hygiene - A Challenge in Everyday Life for People with Schizophrenia

The aim of the study is to explore how adults with schizophrenia describe their lived experiences with oral hygiene. 23 adults with schizophrenia were interviewed within a period of four months in late 2015. Transcriptions of the interviews were analysed using the Reflective Lifeworld Research phenomenological approach of Dahlberg, Dahlberg, and Nyström. The essence of the phenomenon, oral hygiene, is described as a challenge: a mixture of ability and assigning priority; a challenge in which significant others, for better or worse, play an important role. We recommend a systematic cooperation between health care professionals and adults with schizophrenia in order to improve oral health, well-being and recovery.

Perceptions of oral health by those living with mental illnesses in the Victorian Community - The consumer's perspective

OBJECTIVE

To understand the way people living with mental illness in an Australian community experience and define oral health.

STUDY POPULATION

People living with serious mental illness in the Victorian Community.

METHODS

Qualitative methodologies were used in this study. Two focus groups and four semi-structured interviews were conducted. The data were transcribed and thematically analysed.

RESULTS

Participants generally valued oral health and recognized that attending regular dental appointments played a key role in improving their oral health. Participants felt that their mental illness overwhelmed their ability to maintain good oral health. Coping, dental fear, stigma, financial barriers and communication were identified as issues around utilization and access to care.

DISCUSSION

Experiences of oral health were both positive and negative. Barriers and enablers, extending beyond participant oral health literacy for oral health, were identified from the data, and recommendations around personal, environmental and clinical supports were made.

CONCLUSION

This is a valuable study that provides new insight into a complicated issue. Recommendations to create a supportive dental environment and direction to improve the dental experience have been made to make oral health more accessible for people living with mental illness. Recommendations have also been made for community-based mental health organizations to aid the improvements in oral health with this group of people, thus building a collaborative approach to support oral health for this vulnerable group.

Barriers and enablers for oral health care for people affected by mental health disorders

BACKGROUND

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies.

RESULTS

The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.

CONCLUSIONS

Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Signs of bruxism and temporomandibular disorders among patients with bipolar disorder

Background/Aim: There is an abundance of data regarding temporomandibular disorders (TMD) and bruxism specific to patients with bipolar disorder (BD). This study aimed to investigate the prevalence of TMD signs in subjects with and without BD. Material and Methods: The case group included 242 adult patients (103 men and 139 women) with BD and the control group included 187 subjects without BD (89 men and 98 women). The case and control groups were compared for the presence of bruxism and the signs of TMD including muscle and temporomandibular joint (TMJ) tenderness to palpation, limitation of maximum mouth opening, and TMJ sounds. Results: The frequency of at least one sign of TMD was significantly higher in patients with BD (191 ⁄242, 78.9%) than the control group (95 ⁄187, 50.8%) (p<0.001). Statistically significant differences were found between the case and control groups in terms of joint pain on palpation (p<0.05), masseter muscle pain on palpation (p<0.01), joint clicks (p<0.001) and limited mouth opening (p<0.001). Bruxism was significantly higher in patients with BD (49.6%) than the control group (19.8%) (p<0.001). Conclusions: Patients with BD appear to be more prone to having TMD signs and bruxism compared to the control group, but this comorbidity should be better understood by further studies.

Oral Hygiene in Patients With Severe Mental Illness: A Pilot Study on the Collaboration Between Oral Hygienists and Mental Health Nurses

PURPOSE

To test (a) the effects of an educational intervention about oral hygiene on the knowledge of mental health nurses, and (b) the effects of an oral care intervention on oral health in patients with severe mental illness (SMI).

DESIGN AND METHODS

We applied a pretest/posttest design to test improvements in nurses' knowledge and the oral health of SMI patients.

FINDINGS

The nursing staff's knowledge increased significantly after the educational intervention. The oral health of the patients improved significantly after the oral health intervention.

PRACTICE IMPLICATIONS

Oral health of SMI patients can improve significantly with basic oral health interventions carried out by collaborating oral hygienists and mental health nurses.

Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study

OBJECTIVES

Individuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so.

DESIGN

Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization.

SETTING

Six community pharmacy locations.

PARTICIPANTS

Adults (≥18 years of age) filling prescriptions for psychotropic medications.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist.

RESULTS

Participants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths "always" or "frequently" felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P <0.01) and rated their oral health as significantly worse (P <0.001) than participants whose mouths "never" or "occasionally" feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P <0.05).

CONCLUSION

One in 4 patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients.

Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care

OBJECTIVE

Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side-effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical health conditions, including cancer, fractures and complications of surgery. We set out to examine the literature on disparities in medical and dental care experienced by people with schizophrenia and suggest possible approaches to improving health.

METHOD

This narrative review used a targeted literature search to identify the literature on physical health disparities in schizophrenia.

RESULTS

There is evidence of inequitable access to and/or uptake of physical and dental health care by those with schizophrenia.

CONCLUSION

The goal was to reduce the mortality gap through equity of access to all levels of health care, including acute care, long-term condition management, preventative medicine and health promotion. We suggest solutions to promote health, wellbeing and longevity in this population, prioritising identification of and intervention for risk factors for premature morbidity and mortality. Shared approaches are vital, while joint education of clinicians will help break down the artificial mind-body divide.

Access to dental care and dental ill-health of people with serious mental illness: views of nurses working in mental health settings in Australia

People with serious mental illness experience higher rates of oral and dental health problems than the wider population. Little is known about how dental health is viewed or addressed by nurses working with mental health consumers. This paper presents the views of nurses regarding the nature and severity of dental health problems of consumers with serious mental illness, and how often they provide advice on dental health. Mental health sector nurses (n = 643) completed an online survey, including questions on dental and oral health issues of people with serious mental illness. The majority of nurses considered the oral and dental conditions of people with serious mental illness to be worse than the wider community. When compared with a range of significant physical health issues (e.g. cardiovascular disease), many nurses emphasised that dental and oral problems are one of the most salient health issues facing people with serious mental illness, their level of access to dental care services is severely inadequate and they suffer significantly worse dental health outcomes as a result. This study highlights the need for reforms to increase access to dental and oral health care for mental health consumers.

Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper

Patients with psychiatric problems show a tendency to develop temporomandibular disorders (TMD). Particularly, patients with schizophrenia are quite likely to have signs and symptoms of TMD due to the impairment of their oral health, the use of antipsychotic drugs, and other general health problems. In nonschizophrenic populations, TMD have been considered as the main cause of nondental pain in the orofacial region, involving mechanisms associated with changes in masticatory activity at the cortical and neuromuscular levels. Individuals with schizophrenia do not usually complain of pain, and TMD is misdiagnosed in this population. In this paper, we aimed to review the clinical aspects of TMD in people with schizophrenia on antipsychotic drug therapy.

An oral health intervention for people with serious mental illness (Three Shires Early Intervention Dental Trial): study protocol for a randomised controlled trial

Background

Oral health is an important part of general physical health and is essential for self-esteem, self-confidence and overall quality of life. There is a well-established link between mental illness and poor oral health. Oral health problems are not generally well recognized by mental health professionals and many patients experience barriers to treatment.

Methods/Design

This is the protocol for a pragmatic cluster randomised trial that has been designed to fit within standard care. Dental awareness training for care co-ordinators plus a dental checklist for service users in addition to standard care will be compared with standard care alone for people with mental illness. The checklist consists of questions about service users’ current oral health routine and condition. Ten Early Intervention in Psychosis (EIP) teams in Nottinghamshire, Derbyshire and Lincolnshire will be cluster randomised (five to intervention and five to standard care) in blocks accounting for location and size of caseload. The oral health of the service users will be monitored for one year after randomisation.

Trial registration

Current Controlled Trials ISRCTN63382258.

An oral ulceration associated with Morgellons disease: a case report

Morgellons disease is a psycho-dermatologic condition in which patients report fibers or filaments "growing" out of their skin. This case report highlights an oral ulceration in a young woman associated with Morgellons disease, a condition that has not been previously described in the dental literature. An increasing number of individuals are self-reporting this condition and oral health care providers must be familiar with this disorder.