A Systematic Review and Meta-Analysis of the Association Between Periodontal Disease and Severe Mental Illness

Can social adversity and mental, physical and oral multimorbidity form a syndemic? A concept and protocol paper

Background

Clustering mental, physical and oral conditions reduce drastically the life expectancy. These conditions are precipitated and perpetuated by adverse social, economic, environmental, political and healthcare contextual factors, and sustained through bidirectional interactions forming potentially a 'syndemic'. No previous study has investigated such potential syndemic. Thus, the present project aimed to (i) test for syndemic interactions between social adversity (socioeconomic adversity and traumatic events) and mental, physical and oral multimorbidity using the syndemic theoretical framework; and (ii) determine whether the syndemic relationships vary by age, sex and ethnicity.

Methods

Data from three large-scale population-based databases: UK BioBank, US National Health and Nutrition Examination Survey (NHANES) and the Research with East London Adolescents Community Health Survey (RELACHS) will be analysed. Structural equation modelling (SEM) will be utilised to conceptualise syndemic factors and model complex relationships between directly observed and indirectly observed (latent) variables (syndemic constructs).

Discussion

the syndemic conceptualisation provides a valuable framework to understand health and illness, and hence to better design and deliver effective and cost-effective preventative and curative integrated (syndemic) care to improve patient and population health. Such syndemic care aims to address the social determinants of health, whilst simultaneously managing all interlocked conditions.

Burden and impact of periodontal diseases on oral health-related quality of life and systemic diseases and conditions: Latin America and the Caribbean Consensus 2024

Periodontal diseases are highly prevalent globally, and represent a significant public health burden that could affect the quality of life in Latin American and in Caribbean countries and territories. The primary objective is to explore the existing research and epidemiological studies on the burden of periodontal diseases, particularly their impact on oral health-related quality of life (OHRQoL) and associations with systemic health conditions in Latin America and the Caribbean (LAC). An electronic literature search was conducted across multiple databases, including MEDLINE (PubMed), Scopus, LILACS, SciELO, and Web of Science, without publication date or language limitations, up until December 2023. Reviewers independently assessed titles and abstracts based on the eligibility criteria. The search yielded 1195 articles, with 63 meeting the inclusion criteria. The results of epidemiological studies showed that periodontitis is extremely prevalent at 90% in LAC; severe periodontitis can affect nearly 10% of the adult population and that periodontitis is aggravated by smoking, poverty, low education level, and limited access to proper dental care. Periodontitis was consistently associated with worse OHRQoL; and causing pain, and/or triggering psychological discomfort, physical disability, and social disability. Associations were also reported between periodontitis and comorbidities such as diabetes, cardiovascular disease, rheumatoid arthritis, respiratory disease, mental illness, and adverse pregnancy outcomes that are also affecting the quality of life of individuals and their families. This scoping review offers a thorough examination of the burden of periodontal diseases in LAC and highlights the significant public health concern that it represents for the region.

Health topics emerged from brief-motivational interviewing: A randomized clinical trial

OBJECTIVE

The goal of this study was to analyse transcription of audio recordings to determine health topics that emerged from brief-motivational interviewing (MI) compared to traditional oral hygiene instructions (OHI).

METHODS

Fifty-eight periodontal maintenance patients were randomized to a brief-MI or traditional OHI group for a longitudinal 1-year clinical trial. Both groups received four patient education sessions per their assigned group. Audio recordings were transcribed and coded. The overarching themes and subthemes emerged were quantified and reported as the number of instances per participant. Global scores and behavioural counts were compared across baseline, 4, 8, and 12-month research visits using mixed-effect models.

RESULTS

Of the six overarching themes, the brief-MI group evoked more topics toward total health. Oral home care behaviours (15 vs. 10.2) and oral diseases/conditions (3.3 vs. 1.9) were discussed more in the brief-MI group compared to the traditional OHI group. This positive outcome for the average number of times a health topic was discussed in the brief-MI group compared to the traditional OHI group continued for the remaining major themes: lifestyle behaviours (1.0 vs. 0.4), nutrition (2.6 vs. 0.8), emotional/mental health (1.8 vs. 0.8) and general health (1.2 vs. 0.4).

CONCLUSION

This study identified that brief-MI was a more successful communication approach to increase discussions of oral home care behaviours, oral diseases/conditions, lifestyle behaviours, nutrition, emotional/mental health and general health compared to traditional OHI in individuals with periodontitis.

Mental Disorders and Oral Diseases: Future Research Directions

The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.