Oral health problems and support as experienced by people with severe mental illness living in community-based subsidised housing--a qualitative study

Oral health and oral health needs among patients with serious mental illness: reflections and experiences of psychiatric staff in Sweden

BACKGROUND

Due to organizational structures, there is a gap between psychiatric and dental care services that limits collaboration and knowledge sharing, and this can have a negative impact on patients' oral health or general health and vice versa. To facilitate the integration between dentistry and psychiatry, more insight and knowledge is needed on psychiatric staffs' work with patients' oral health. Therefore, the aim of this study was to explore the experiences of psychiatric staff regarding patients' oral health and meeting their oral health needs.

METHODS

Using a semi-structured guide, staff (n = 13) in Swedish psychiatric and forensic settings and in municipal housing support services were interviewed about their experiences with patient oral health. The interviews took place between April 2022 and June 2023. The data were analysed with inductive qualitative content analysis.

RESULTS

This study identified challenges such as organizational issues, complex administrations, and a lack of tools for integrating oral health into psychiatric care. The patients perceived to face daily health-related challenges, and the informants identified opportunities to include oral health into tools for health promotion and the facilitation of healthy lifestyle changes.

CONCLUSION

Psychiatric staff possess central knowledge and insight into the life situations of patients with severe mental illness, and psychiatric staff consider dental staff to be key partners. Collaboration between psychiatric and dental staff is essential for developing strategies to integrate oral health perspectives into current screening and psychopedagogical models and practices.

Establishing an empirical conceptual model of oral health in dependent adults: Systematic review

AIM

This qualitative evidence synthesis was performed to establish a conceptual model of oral health in dependent adults that defines the construct of oral health and describes its interrelationships based on dependent adults' and their caregivers' experiences and views.

METHODS

Six bibliographic databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, OATD, and OpenGrey. Citations and reference lists were manually searched. A quality assessment of included studies was conducted independently by two reviewers using the Critical Appraisal Skills Programme (CASP) checklist. The 'best fit' framework synthesis method was applied. Data were coded against an a priori framework and data not captured by this framework were thematically analyzed. To assess the confidence of the findings from this review, the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used.

RESULTS

Twenty-seven eligible studies were included from 6126 retrieved studies. Four themes were generated to further understand oral health in dependent adults: oral health status, oral health impact, oral care, and oral health value.

CONCLUSION

This synthesis and conceptual model offer a better understanding of oral health in dependent adults and subsequently provide a starting point to guide establishment of person-centred oral care interventions.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.

Effectiveness of a Therapeutic Educational Oral Health Program for Persons with Schizophrenia: A Cluster Randomized Controlled Trial and Qualitative Approach

BACKGROUND

The oral health of people with schizophrenia (PWS) is very poor, suggesting a need for oral health promotion programmes with a high level of evidence. The aim of the EBENE study (Clinicaltrials.gov: NCT02512367) was to develop and evaluate the effectiveness of a multidisciplinary therapeutic educational programme in oral health (TEPOH) for PWS.

METHODS

A multicentre cluster randomised controlled trial, with outpatient psychiatry centres as the unit of randomisation, was designed to compare the effectiveness of TEPOH (intervention group) versus standard care (control group). The trial was conducted in 26 outpatient psychiatry centres in France (14 in the intervention group, 12 in the control group). Eligible patients with a diagnosis of schizophrenia were enroled between 2016 and 2020 and followed for 6 months. The TEPOH group received a multicomponent intervention (comprising an introductory session, three educational sessions, and a debriefing session). The primary endpoint was the evaluation of periodontal disease as a community periodontal index (CPI) score ≥ 3 at Month 6. The trial was completed using a qualitative approach based on semi-structured interviews with caregivers conducted between July 2018 and December 2019. The trial was stopped early due to difficulties in recruiting patients.

RESULTS

Overall, 81 patients (of 250 planned) were included, and 54 patients completed the trial: 40 in the TEPOH group and 14 in the control group. At baseline, the percentage of CPI ≥ 3 was 42.5% in the TEPOH group and 9.1% in the control group. At Month 6, the percentage of CPI ≥ 3 was 20% in the TEPOH group and 14.3% in the control group. The qualitative evaluation underlined that the professionals emphasised the "seriousness" and "assiduity" of the patients' participation in this programme and that the TEPOH reinforced carers' investment in oral hygiene. It also highlighted structural factors (lack of resources for professionals, lack of teeth in PWS, COVID-19 pandemic) that may have exacerbated the difficulties with enrolment and follow-up.

CONCLUSIONS

The effectiveness of this TEPOH, developed for PWS as part of the EBENE study, has not been demonstrated. Certain aspects of the programme's content and implementation need to be reconsidered. In particular, an adapted subjective measurement scale should be developed.

Moderating effects of resilience and self-esteem on associations between self-reported oral health problems, quality of oral health, and mental health among adolescents and adults in Nigeria

BACKGROUND

There is an intersection between oral and mental health though the studies on these intersections are few. This study investigated associations between self-reported oral health problems, quality of oral health, and depression and general anxiety among adolescents and adults in Nigeria; and analysed the moderating effects of resilience and self-esteem on these associations.

METHODS

In this secondary analysis, data were extracted from the database of an online survey conducted among participants 13 years and older and living in Nigeria about their self-reported psychological wellbeing. The data was collected between September and October 2020. Dependent variables were self-reported presence of oral health problems (yes/no) and self-reported quality of oral health (using a five-item scale ranging from "very good" to "very poor"). Independent variables were depressive and anxiety symptoms. Moderating factors evaluated were resilience and self-esteem. Multivariable logistic regression analysis was used to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, employment status and educational status). A path analysis was conducted to determine the moderating effects of self-esteem and resilience on associations between dependent and independent variables.

RESULTS

We extracted data for 2,757 adolescents and adults aged 13 to 62 years, of which 2,062 (74.8%) reported having oral health problems and 925 (33.6%) reported poor quality of oral health. Higher levels of depressive symptoms were significantly associated with higher odds of oral health problems (AOR: 1.07; 95% CI: 1.04-1.10; p<0.001). Higher levels of depressive symptoms (AOR: 1.05; 95% CI: 1.03-1.07; p<0.001), and higher levels of anxiety symptoms (AOR: 1.07; 95% CI: 1.04-1.11; p<0.001) were significantly associated with poor quality of oral health. Resilience significantly moderated the association between anxiety symptoms and oral health problems (AOR = -0.004; 95% CI: -0.006 --0.001; p = 0.002).

CONCLUSION

Depression may be a risk indicator for self-reported oral health problems, while depression and anxiety appear to be risk indicators for self-reported poor quality of oral health. These factors could be included as confounders in future studies on oral health problems and quality of oral health among adolescents and adults in Nigeria.

Enabling people with severe mental illness to overcome barriers to access dental treatment: a qualitative study applying COM-B framework analysis

BACKGROUND

The oral health of people with severe mental illness is severely compromised. Rates of premature total tooth loss and tooth decay are substantially higher than in the general population. Causation is complex, restricted access to treatment a major contributing factor.

AIMS

To examine factors enabling people with complex problems related to severe mental illness to attend scheduled dental appointments.

METHOD

Qualitative semi-structured interviews were conducted with 15 service users who attended no-cost treatment at a university clinic, following oral health screening at an inner-city community mental health service. Analysis used a framework approach informed by a theoretical model of behaviour (COM-B).

RESULTS

Complex individual motivations, related variously to function, pain and/or self or social appraisal, were also influenced by expectations of treatment. Capabilities included managing "messy" life circumstances; participants overcame various psychological and physical challenges to attend treatment, enabled by opportunities of social and instrumental support.

CONCLUSIONS

Genuine partnerships between agencies to provide access opportunities, in addition to individual support responsive to personal motivators and adapted to capabilities can enable access to services and improve the lives of people with severe mental illness.

Study of the Unidimensionality of the Subjective Measurement Scale of Schizophrenia Coping Oral Health Profile and Index: SCOOHPI

Background: The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) scale studies the coping strategies of schizophrenic patients with regard to oral health. The structural validity of this scale is studied has been studied using factor analyses. In this article, we study the unidimensionality of the SCOOHPI scale to use it as an index. Methods: We studied the internal consistency of the items of the SCOOHPI scale. Then, we studied the construct validity. The unidimensionality of the SCOOHPI scale was studied by the partial credit model. Results: The data used in this study come from five hospitals, and the total number of individuals participating in this study is 96, of which 72% are men and 59% are smokers. The SCOOHPI scale has good internal consistency (α = 0.84). The validity of divergence was checked by the absence of correlation between the SCOOHPI scale and the GOHAI (General Oral Health Assessment Index) scale. The unidimensionality of the SCOOHPI scale with data smoothing was demonstrated by the partial credit model. Conclusion: In this study, we completed the study of the psychometric validation of the SCOOHPI. The SCOOHPI scale can then contribute to improving evaluation of the coping strategies of schizophrenic patients with regard to oral health.

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.

Impact of the COVID-19 pandemic on oral health and psychosocial factors

The objective of this study was to investigate oral health-related quality of life (OHRQoL) in times of the COVID-19 pandemic and to examine a possible association to psychosocial factors like psychological stress and symptoms of depression and anxiety disorders. Secondary research questions were whether people changed oral hygiene regimens during the COVID-19 pandemic and to what extent dental symptoms existed and developed compared to pre-pandemic. For this cross-sectional study a survey has been conceptualized to determine OHRQoL, stress, depression and anxiety and their specific confounders in a German cohort. Validated questionnaires as OHIP-G14, PHQ-Stress and PHQ-4 have been implemented. Altogether 1178 participants completed the survey between May and August 2020. The overall OHIP-G14 sum score of 4.8 ± 7.5 indicated good OHRQoL. 21% of the participants (n = 248) reported toothache, 23% (n = 270) mucosal problems, 31% (n = 356) hypersensitivity of the teeth and 27% (n = 305) myofacial pain. The PHQ-Stress score (4.5 ± 3.5) demonstrated a mild severity of stress. Depression and anxiety level has been mild to moderate (PHQ-4 score: 2.4 ± 2.6). 38% of the participants stated subjectively greater emotional burden compared to pre-pandemic. Statistically significant differences exist for OHRQoL, stress, anxiety and depression levels between participants with greater, equal or less emotional burden compared to pre-pandemic. COVID-19 history and aggravated levels of depression, anxiety, and stress seem to associate with lower OHRQoL. Psychosocial consequences during pandemic times and their association to oral health should be further investigated.

Improving oral health in people with severe mental illness (SMI): A systematic review

BACKGROUND

Those with severe mental illness (SMI) are at greater risk of having poor oral health, which can have an impact on daily activities such as eating, socialising and working. There is currently a lack of evidence to suggest which oral health interventions are effective for improving oral health outcomes for people with SMI.

AIMS

This systematic review aims to examine the effectiveness of oral health interventions in improving oral health outcomes for those with SMI.

METHODS

The review protocol was registered with PROSPERO (ID CRD42020187663). Medline, EMBASE, PsycINFO, AMED, HMIC, CINAHL, Scopus and the Cochrane Library were searched for studies, along with conference proceedings and grey literature sources. Titles and abstracts were dual screened by two reviewers. Two reviewers also independently performed full text screening, data extraction and risk of bias assessments. Due to heterogeneity between studies, a narrative synthesis was undertaken.

RESULTS

In total, 1462 abstracts from the database search and three abstracts from grey literature sources were identified. Following screening, 12 studies were included in the review. Five broad categories of intervention were identified: dental education, motivational interviewing, dental checklist, dietary change and incentives. Despite statistically significant changes in plaque indices and oral health behaviours as a result of interventions using dental education, motivational interviewing and incentives, it is unclear if these changes are clinically significant.

CONCLUSION

Although some positive results in this review demonstrate that dental education shows promise as an intervention for those with SMI, the quality of evidence was graded as very low to moderate quality. Further research is in this area is required to provide more conclusive evidence.

Dimensional Structure and Preliminary Results of the External Constructs of the Schizophrenia Coping Oral Health Profile and Index (SCOOHPI)

The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) was developed to assess oral health coping strategies in people with schizophrenia. We show that the difficulty and discrimination indices of 18 items, selected for the final version, are acceptable according to the Rasch model, as are the inter-item (0.25) and inter-score (α = 0.85) correlations. This scale can be considered as an index, giving a global score between 0 and 72, with a Likert scale with five response modalities. This is also a profile with the following three dimensions of coping-related oral health, emerging independently of each other: (1) physical well-being strategies (α = 0.72); (2) moral well-being strategies (α = 0.60); (3) access strategies for oral well-being (α = 0.79). The sub-scores, ranging from 0 to 24, specify populations focused on the themes of coping strategies that may be most affected, depending on the subject's characteristics and their clinical oral health status. The validation study of this scale is still in progress, to evaluate the reproducibility of the results, sensitivity to change, and reliability for other populations of people with schizophrenia.

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.

Barriers and facilitators for dental care among patients with severe or long-term mental illness

Background

Persons who struggle with severe or long‐term mental illness (SMI) have a higher prevalence of oral health problems than the general population. Obtaining and continuing dental treatment is challenging for this patient group for many reasons, and many drop out of active treatment. Our study aimed to explore perceived barriers to obtaining optimal dental health care for patients with SMI. Further, we sought to identify possible ways to facilitate for providing true access to dental services for this population.

Methods

The study utilised a flexible qualitative design with data collected during ordinary clinical practice in a public dental clinic in Norway. We conducted semi‐structured face‐to‐face interviews with 51 persons with SMI twice: an initial interview before dental treatment and a final one after dental treatment. We applied the thematic analysis method.

Results

Thematic analysis revealed two key themes in the participants’ experiences of access to dental health services: practical conditions and relationship with the dentist. Patients reported barriers and facilitators for access to care as factors associated with patients (patient factors), with the dentist (dentist factors) and with healthcare services (system factors).

Conclusions

Our study indicates that persons with SMI appreciate oral health and want to obtain needed oral care and dental treatment, but they encounter barriers on several fronts. The participants offered suggestions for how to facilitate attendance and adherence. Our findings suggest that dental healthcare services require reorganisation to meet the needs of patients with SMI.

Barriers Affecting the Oral Health of People Diagnosed with Depression: A Systematic Review

Introduction

The problems of oral health of people diagnosed with depression are not adequately recognized, either in developed or developing countries. Social stigma, lack of self-interest, or even inadequate approaches of dental doctors towards the unique situation of this group of people this lead to excessive oral health problems.

Methods

The bibliographic database PubMed/Medline, Google Scholar, and Whiley online library were searched using the following text and MeSH as separate key terms and in combination: depression and oral health/dental caries/periodontal disease/tooth loss/utilization of oral health services/and barriers. The content of documents was analysed using qualitative methodology.

Results

Twenty-six original studies were included in the review. Level/severity of depression, medication and medical comorbidity are the most important medical barriers influencing the oral health of people diagnosed with depression. Dental fear and anxiety are mostly combined with low oral hygiene and bad oral health. Socioeconomic status, dental insurance, bad habits and education also have important roles in the oral health status of people diagnosed with depression.

Conclusion

Including individuals with depression and oral health problems in national health programs, creating specific prevention programs, or subsidizing the cost of treatment are some of the recommendations suggested as solutions.

Anticholinergic Drugs and Oral Health-related Quality of Life in Patients with Schizophrenia: A Pilot Study

OBJECTIVE

The aim of this study was to explore, in a sample population of people with schizophrenia (PWS), the role of the anticholinergic burden on the perception of oral health-related quality of life (OHrQoL) in France.

METHODS

A pilot study was performed between March 2014 and January 2016. PWS were recruited from a population in Côte d'Or department in France. Dental status was investigated using the Decayed, Missing, or Filled Teeth (DMFT) index, the Xerostomia Index (XI), and the Global Oral Health Assessment Index (GOHAI) for OHrQoL. The anticholinergic impregnation score was recorded using the anticholinergic impregnation scale (AIS).

RESULTS

A sample of 62 people was selected. The DMFT score was 16.5± 8.7, the XI score was 22.9±7.8, the GOHAI score was 43.0±8.8, and the AIS score was 3.1±2.8. In total, 169 drugs were prescribed to the people of our sample, and 114 different anticholinergic drugs were observed. The most frequently used anticholinergic drugs (51.40%), in the study had a low antimuscarinic potency (1 point according to AIS scale). The multiple linear regression model showed that the OHrQoL scores were significantly lower when the DMFT scores, XI score, and anticholinergic scores were high.

CONCLUSIONS

This pilot study highlighted the potential role of the anticholinergic burden on the OHrQoL of PWS. A study with a validated specific scale for the OHrQoL and a standard anticholinergic burden scale should be conducted to clarify the role of anticholinergic drugs on the OHrQoL for PWS.

Coping Strategies for Oral Health Problems by People with Schizophrenia

BACKGROUND

Persons with schizophrenia are particularity susceptible to poor oral health. Symptoms of schizophrenia often affect oral health behaviors and lifestyle. The aim was to explore coping strategies used by people with schizophrenia in oral health in order to understand and to best involve them in the management of their own oral health in daily life.

MATERIALS AND METHODS

This is systematic review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. We included cross-sectional and longitudinal quantitative and qualitative studies that 1) examined coping strategies regarding oral health in persons with schizophrenia or 2) examined coping strategies were used in dental care. We included studies conducted with at least one PWS aged 18 years old more and without restriction on sex, socioeconomic status, or language.

RESULTS

The 8 studies included suggest that coping strategies depends on complex translation processes that can be either personal (e.g., psychological symptomatology, neuropsychological functioning to adversely affect hope, self-esteem, self-stigma, self-determination, sense of coherence, and resilience) and/or environmental factors (e.g., peer support and efficacy of rehabilitations programs). We further identified that the main factor influencing coping strategies was dental stress situation.

CONCLUSIONS

This review suggests that coping strategies play a crucial role in the recovery process for oral health of PWS. Translation processes in oral health should be more explored in the future to clarify the capacity of PWS to cope with essential self-care in oral health on daily life.

The Schizophrenia Coping Oral Health Profile. Development and Feasibility

BACKGROUND

The aim of this work was to present the creation of appropriate tools to evaluate the coping strategies in Oral-Health-related Quality of Life (OHrQOL) implemented by persons with schizophrenia (PWS), the Schizophrenia Coping Oral Health Profile (SCOOHP), and the results of a feasibility study.

METHODS

A qualitative investigation was conducted between June 2016 and May 2017.The first step included 26 semi-structured individual interviews, 20 with PWS and 6 with health professionals (HPs), and 2 focus groups (PWS and HPs) to explore the experiences of the participants and how they felt about coping strategies in OHrQOL. The second step was a feasibility study involving a statistical analysis to test the acceptability and internal consistency (Cronbach's α) of the SCOOHP.

RESULTS

The analysis of these interviews allowed for us to obtain 277 items from 3545 verbatim transcriptions related to various dimensions of OHrQOL. We presented the items selected in coping concepts in this study. After selecting items in several stages, we drew up the SCOOHP scale with 23 items (15 items for positive coping and 8 items for negative coping). The feasibility study showed good acceptability, good understanding of the items and good consistency reliability (α = 0.59).

CONCLUSIONS

This is the first study that has enabled us to draw up a specific tool to assess coping strategies in OHrQOL of PWS. A multicentre study involving a larger sample of PWS is underway in order to perform the psychometric validation of the SCOOHP.

TRIAL REGISTRATION

Clinical Trials Gov NCT02730832. Date registered: 21 March 2016.

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.

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.

A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility

Social factors, health behaviours and the direct effects of substances contribute to the poor oral health and restricted access to dental services experienced by people who are dependent on drugs and/or alcohol. Admission for inpatient withdrawal management provides an opportunity for intervention to promote oral health but to be effective it must be acceptable to patients. To support intervention design, we examined patients' views about oral health, practices and treatment access, and appropriateness of health-promoting intervention in this context. Given paucity of knowledge in the area we employed a qualitative approach, data were collected in semi-structured interviews with inpatients of a public specialist alcohol and drug unit in Australia in September 2014. Analysis employed the framework approach. All 14 participants wanted 'good teeth' but few diligently attended to oral healthcare; most sought assistance only in emergencies. Participants' knowledge of services was limited and practical and affective barriers hindered access. With none recalling attention to oral health during admission, support was strong for incorporation of oral health in inpatient assessments. Participants wanted information about the impact of substances on oral health and oral hygiene practices provided in various formats, and facilitated referral to non-judgemental, affordable treatment. Patients regarded promotion of oral health in the inpatient context as important, relevant and acceptable. Support should respect the different knowledge, practices and motivations for oral health and recovery, of patients. Addressing practical and affective barriers to dental services will require collaboration between drug and alcohol and dental services, and this should be the focus of further research.

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) » in a French representative sample of patients with schizophrenia

BACKGROUND

The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia.

METHODS

A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects.

RESULTS

The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05).

CONCLUSION

Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients.

TRIAL REGISTRATION

Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.

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.

Study protocol: a cluster randomized controlled trial to assess the effectiveness of a therapeutic educational program in oral health for persons with schizophrenia

BACKGROUND

Schizophrenia is a severe mental disorder that affects 1 % of the world's population, including 600,000 people in France. Persons with schizophrenia (PWS) have excess mortality (their life expectancy is reduced by 20 %) and excess morbidity. In addition, such persons may have a large number of missing or decayed teeth. Dental caries and periodontal measurement indexes are often twice as high as the level found in the general population. Poor oral health can also affect quality of life and oral health is inseparable from general health. The management of oral health problems needs a multidisciplinary approach. According to the World Health Organization, the aim of therapeutic education (TE) is to help patients take care of themselves and to improve empowerment and recovery. In this educational approach, it is important to take into account the patient's personal experience. Though rarely investigated, the personal experience of PWS in oral health quality of life (OHRQoL) must be used to build a therapeutic educational programme in oral health (TEPOH) in a multidisciplinary approach, and the effectiveness of this program must be evaluated.

METHODS/DESIGN

We report the protocol of a randomized controlled cluster study. This study will be conducted in twelve hospitals in France. We hypothesized that a decrease of 20 % in the proportion of patients with CPI ≥ 3 would establish the effectiveness of TEPOH. Therefore, 12 hospitals will be randomly allocated to either TEPOH or no TEPOH. Altogether, they will have to recruit 230 PWS, who will be randomly allocated with a ratio of 1:1 to one of two conditions: control without intervention versus the group benefitting from TEPOH.

DISCUSSION

If successful, the study will generate methodologically sound results that provide knowledge on the effectiveness of a TEP in oral health for PWS. The results can be used to promote OHRQoL in a global health approach and develop appropriate strategies to encourage and facilitate financial support for healthcare, the multidisciplinary treatment of dental disorders, and the development of training in oral and mental health for caregivers. Trial registration Clinical Trials Gov NCT02512367. Date registered 19 July, 2015.

Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy

OBJECTIVE

Polypharmacy is a common cause of xerostomia. This study aimed to investigate whether xerostomia could be an adverse drug event of mouthwashes, when they are used for longer than 2 weeks by patients taking polypharmacy.

MATERIALS AND METHODS

This cross-sectional observational study included 120 hospitalized patients (60 middle-aged and 60 elderly patients), taking polypharmacy (≥4 drugs daily) and at risk of drug-induced xerostomia. Xerostomia was assessed by questioning participants.

RESULTS

A total of 62.5% of patients complained of xerostomia. In the middle-aged group (mean age=44.0 (8.7) years; 35.0% women) xerostomia seemed independently associated to mouthwashes, at the limit of significance (OR=5.00, 95% CI=0.99-25.3, p=0.052). Active principles in mouthwashes were mainly quaternary ammonium compounds (91.9%). Mouthwashes may disturb the healthy balance of the biofilm moisturizing the oral mucosa. The biofilm contains mucins, salivary glycoproteins with oligosaccharides side chains able to sequester water and endogenous bacteria surrounded by a glycocalyx. Oral bacteria are fully susceptible to quaternary ammonium (chlorhexidine, hexetidine, cetylpyridinium chloride) and to other antiseptics used in mouthwashes, such as betain, resorcin, triclosan, essential oils and alcohol. However, caregivers currently recommend such dental plaque control products to patients suffering from xerostomia in order to reduce the risk of caries and periodontitis.

CONCLUSION

This study is the first report that use of antiseptic mouthwashes for more than 2 weeks could worsen xerostomia in patients taking polypharmacy. Oral care protocols should avoid this iatrogenic practice, particularly when xerostomia alters the quality-of-life and worsens malnutrition.

Oral health in adults with serious mental illness: needs for and perspectives on care

This study used qualitative methods to investigate barriers to and facilitators of oral health care among 25 adult community mental health outpatients with serious mental illness (SMI). Participants completed 30- to 60-min, semi-structured interviews that were recorded and transcribed. Qualitative analysis was used to characterize common themes. Results showed that lack of awareness of dental problems, poverty, and dental care access were key barriers to oral health care. When oral health care was accessed, fear of stigma was associated with missed opportunities to educate about the intersection of mental and oral health. Community mental health providers were viewed as trusted and important sources of advocacy and support for obtaining oral health care when needed. Oral health may be improved for persons with SMI by implementing education in points of frequent service contact, such as community mental health.

Oral health impacts and quality of life in an urban homeless population

BACKGROUND

Homeless people experience a much higher burden of general health conditions and have much poorer oral health than the rest of the population. The aim of this study was to determine the oral health impacts and general quality of life of an urban homeless population.

METHODS

A convenience sample of 58 adults (dentate n = 56) experiencing homelessness were assessed using a survey which included the 14-item Oral Health Impact Profile and the 26-item World Health Organization's Quality of Life - short version. A subset (n = 34) also underwent a dental examination.

RESULTS

The study participants were younger, more likely to be Indigenous, smoked daily and avoided dental care because of cost than the rest of the population. Dentate homeless adults reported significantly greater oral health impacts when compared with the Australian dentate population. General quality of life was significantly poorer than for the rest of the population. Treatment need was associated with greater oral health impacts.

CONCLUSIONS

Poor oral health is prevalent and adversely impacts quality of life for homeless people, but it is only one of a range of complex social and health challenges being faced by these individuals. Dental care should be better integrated within homeless support services.

Shakespeare in Prison: affecting health and wellbeing

Purpose

– This research aimed to investigate the impacts of the Queensland Shakespeare Ensemble Prison Project (QSEPP) on the health and wellbeing of participants, specifically with regard to social support.

Design/methodology/approach

– Semi-structured interviews were conducted with prisoners participating in the project to gain insight into perceived sense of support within the QSEPP and across the prison context more broadly.

Findings

– The QSEPP encouraged participants to foster a range of support networks through the development of relationships built on trust, respect and shared experiences. Participants also developed communication skills which may assist with establishing and maintaining supportive relationships inside and outside of prison.

Research limitations/implications

– This research highlights the inevitable challenges for researchers working within the prison context, including: correctional services’ limitations, time and space restrictions and small sample sizes. This research offers some potentially innovative ways to combat such challenges.

Practical implications

– The study highlights the potential of theatre-based interventions in the prison context and their role in fostering social support and enhancing wellbeing.

Social implications

– The research explores the potential role theatre may play in improving the health and wellbeing of a disadvantaged and marginalised group, providing skills to enhance access to supportive networks inside and outside prison.

Originality/value

– To the best of our knowledge this is the first research of its kind and provides valuable insights into the role that theatre may play in fostering social support in the prison context.

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.

Oral health of psychiatric patients: the nurse's perspective

OBJECTIVE

To assess nurses' perspectives on character, prevalence and cause of oral diseases among psychiatric patients and also their approach and suggestions in relation to the care of oral problems.

MATERIALS AND METHODS

A questionnaire-based cross-sectional survey of all cadres of nurses (n = 136) at the Federal Psychiatric Hospital, Benin City, Nigeria, was conducted between December 2010 and January 2011.

RESULTS

Two-thirds (67.6%) of the respondents reported that psychiatric in-patients in comparison with the general population have a higher occurrence of oral and dental problems. Commonly cited reasons for the poor oral health of patients included as follows: sedation for long periods, lack of care by family, psychopathological symptoms, poor access to dentists and lack of oral hygiene advice. The common oral health complaints received by the respondents included toothache, pain from the gums and inability to open the mouth. Majority (91.4%) of respondents claimed to be presently involved with oral care of psychiatric in-patients but oral care delivery is however bedevilled with lot of barriers like uncooperativeness of patients and lack of oral care materials.

CONCLUSION

Oral complaints received are frequent and numerate with limited palliative action rendered. Attaching dentists to psychiatric hospitals and regular training of psychiatric nurses on oral care delivery are recommended to comprehensively cater for the oral health problems of psychiatric in-patients.